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UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


SCHOOL  OF  LAW 
LIBRARY 


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MEDICAL 
JURISPRUDENCE 

FORENSIC    MEDICINE 

AND 

TOXICOLOGY 


R.  A.  WITTHAUS,  A.M.,  M.D. 

Professor  of  Chemistry,  Physics,  and  Hygiene  in  the  University  of  the  City  of  Neiv  York,  etc.,  etc, 

AND 

TRACY  C.  BECKER,  A.B.,  LL.B. 

Counsellor  at  Law, 
Professor  of  Criminal  Law  and  Medical  Jtirispritdence  in  the  University  of  Biiffalo 

WITH  THE  COLLABORATION  OF 

August  Becker,  Esq.;  Chas.  A.  Boston,  Esq.;  W.  N.  Bullard,  M.D. ; 

J.  Clifton  Edgar,  M.D. ;  D.  S.  Lamb,  M.D. ;  W.  B.  Outten,  M.D. ; 

Hon.  Wm.  A.  Poste;  Edward  S.  Wood,  M.D. ; 

E.  V.  Stoddard,  M.D. ; 

Hon.  Goodwin    Brown;    J.  C.  Cameron,   M.D. ;   E.  D.  Fisher,  M.D. ; 

H.  P.  LooMis,  M.D. ;  Roswell  Park,  M.D. ;  Irving  C.  Rosse,  M.D. ; 

F.  P.  Vandenbergh,  M.D. ;  J.  H.  Woodward,  M.D. ; 

George  Woolsey,  M.D. 


VOLUME    ONE 


NEW  YORK 

WILLIAM    WOOD    &    COMPANY 

1894 


Copyright,  1894, 
By  WILLIAM  WOOD  &  COMPANY 


PRESS   OF 

THE    PUBLISHERS'    PRINTING   COMPANY 

132-136  W.   FOURTEENTH  ST. 

NEW    YORK 


CONTENTS. 


PAGE 

Introduction, v 

Medical  Jurisprudence,     .    ' 1 

The    Legal    Relations    of    Physicians    and    Surgeons.     T.  C. 
Becker, 3 

The  Law   of  Evidence  Concerning  Confidential  Communica- 
tions.   Chas.  a.  Boston, 89 

Synopsis  of  the  Laws  Governing  the  Practice  of  Medicine. 
W.  A.  PosTE  and  Chas.  A.  Boston, 135 

Forensic  Medicine. 

Thanatological, 293 

The  Legal  Status  of  the  Dead  Body.     T.  C.  Becker,         .        .  295 

The  Powers  and  Duties  of  Coroners.     A.  Becker,       .        .        .  329 

Medico-Legal  Autopsies.     H.  P.  LooMis 349 

Personal  Identity.     J.  C.  RossE 383 

Determination  of  the  Time  of  Death.     H.  P.  LooMis,        .        .  437 

Medico-Legal  Consideration  of  Wounds.     G.  Woolsey,     .        .  457 

Medico-Legal    Consideration  of  Gunshot  Wounds.     Roswell 
Park, 591 

Death  by  Heat  and  Cold.     E.  V.  Stoddard,  .        .        .627 

Medico-Legal  Relations  of  Electricity.    W.  N.  Bullabd,   .        .  661 

Medico-Legal  Consideration  of  Death  by  Mechanical  Suffoca- 
tion.   D.  S.  Lamb 705 

Death  from  Submersion  or  Drowning.     J.  C.  Rosse,  .        .  793 

Death  from  Starvation.     E.  V.  Stoddard, 813 


II^TEODUOTIOK 

The  terms  Forensic  Medicine,  Legal  Medicine,  and 
Medical  Jurisprudence  have  heretofore  been  used  inter- 
changeably to  apply  to  those  branches  of  state  medicine  and  of 
jurisprudence  which  have  to  deal  with  the  applications  of  med- 
ical knowledge  to  the  elucidation  of  questions  of  fact  in  courts 
of  law,  and  with  the  legal  regulation  of  the  practice  of  medicine. 

Medico-legal  science  therefore  includes  all  subjects  con- 
cerning which  members  of  the  legal  and  medical  professions 
may  seek  information  of  one  another,  each  acting  in  his  profes- 
sional capacity.  It  consists  of  two  distinct  branches:  that 
treating  of  medical  law,  to  which  the  designation  of  Medical 
Jurisprudence  properly  applies;  and  that  relating  to  the  ap- 
plication of  medical,  surgical,  or  obstetrical  knowledge  to  the 
purposes  of  legal  trials.  Forensic  Medicine.' 

The  term  State  Medicine,  which  is  sometimes  erroneously 
used  as  synonymous  with  forensic  medicine,  properly  applies  to 
a  more  extended  field  of  medical  inquiry;  i.e.,  to  all  applica- 
tions of  medical  knowledge  to  the  public  welfare.  State  medi- 
cine, therefore,  while  excluding  medical  jurisprudence,  includes, 
besides  forensic  medicine,  public  hygiene,  medical  ethics,  med- 
ical education,  and  military  and  naval  medicine. 

Toxicology,  the  science  of  poisons,  may  be  divided  into 

'  The  distinction  made  in  the  text  medical  topics,  rather  than  an  ac- 
and  in  the  title  of  this  work  is  not  quaintance  with  the  medical  science 
new.  It  was  recognized  by  the  necessary  for  the  elucidation  of  legal 
father  of  medico-legal  science,  Zac-  subjects.  As  it  is  our  peculiar  ob- 
chias.  in  his  two  prefaces,  one  to  ject  to  unite  the  sciences  and  to  show 
the  "  lector  medicus, "  the  other  to  their  mutual  relevance,  the  title  be- 
the  "  lector  legumperitus"  ("QujBst.  comes  most  applicable  to  this,  al- 
Med.  Leg. ,"  Ed.  Venet. ,  1727,  fol.).  though  it  may  have  been  improperly 
In  a  note  to  the  introduction  of  the  affixed  to  former  works. "  The  title 
"Medical  Jurispi-udence"  of  Dr.  of  one  of  two  existing  French  works 
Paris  and  Mr.  Fonblanque  (the  first  in  wliose  authorship  a  lawyer  is  as- 
work  produced  by  joint  authorship  sociated  is  :  "Traitede  Medeciue  le- 
of  a  physician  and  a  lawyer,  in  1823)  gale,  de  Jurisprudence  medicale  et 
is  the  following  (p.  i.)  :  "Someau-  de  Toxicologie, "  par  Le  Grand  du 
thors  have  objected  to  the  term  Med-  Saulle,  Geo.  Berryer  et  Gab.  Pou- 
ical  Jtirifipruflcnce,  as  impljnng  a  chet,  2ded.,  8vo,  Paris,  1886. 
knowledge  of   the  laws  relating  to 


VI  INTRODUCTION. 

medica„  Toxicology,  whose  object  is  the  prevention  or  cure  of 
all  forms  of  poisoning,  and  forensic  toxicology,  whose  aim  is 
the  detection  of  criminal  poisoning.  In  its  last-named  relation 
toxicology  differs  from  forensic  medicine  in  one  important  par- 
ticular. In  all  cases  other  than  those  of  poisoning  in  which 
questions  involving  medical  knowledge  arise,  the  answers  are 
entirely  within  the  functions  of  the  physician,  the  surgeon,  or 
the  obstetrician,  but  the  problems  of  forensic  toxicology  require 
for  their  solution  the  further  aid  of  the  chemist  and  the  phar- 
macologist. 

Forensic  medicine  is  an  applied  science,  partly  legal,  partly 
medical,  calling  for  information  and  investigation  in  widely 
divergent  lines,  and  becoming  more  minutely  ramified  with  the 
progressive  advances  in  medical  knowledge  and  in  those 
sciences  of  which  medicine  is  itself  an  application.  Its  devel- 
opment has  been  dependent  partly  upon  the  slow  though  pro- 
gressive tendency  of  medicine  from  the  condition  of  an  empiri- 
cal art  toward  that  of  an  exact  science,  and  partly  upon  the 
more  rapid  and  more  advanced  development  of  criminal  juris- 
prudence. Medical  jurisprudence  had  reached  a  high  develop- 
ment during  the  early  history  of  the  Roman  Empire,  and  at  a 
period  long  anterior  to  the  first  recognition  of  forensic  medicine. 

Although  the  literature  of  modern  medico-legal  science  is 
very  largely  written  from  the  medical  point  of  view  and  by 
physicians,  its  earlier  history  is  to  be  found  in  fragmentary 
form,  partly  in  medical  literature,  but  principally  in  the  writ- 
ings of  historians,  in  the  earlier  criminal  codes,  and  in  the  early 
records  of  legal  proceedings. 

In  the  earliest  historical  periods  the  functions  now  exercised 
by  the  priest,  the  lawj^er,  and  the  physician  were  performed  by 
the  same  person,  who,  presumably,  made  use  of  what  medical 
knowledge  he  possessed  in  the  exercise  of  his  legal  functions. 
Among  the  Egyptians  at  a  very  early  period  it  is  certain  that 
medical  questions  of  fact  were  considered  in  legal  proceedings, 
and  that  the  practice  of  medicine  was  subject  to  legal  regulation. 
According  to  Diodorus, '  "  when  a  pregnant  woman  was  con- 
demned to  death,  the  sentence  was  not  executed  until  after  she 
was  delivered. "     The  same  author  tells  us  '^  that  "  the  physicians 

'  "Bibl.  Hist.,"  I.,  ii.,  77;  Miot's         '  L.  c,  I.,  ii.,82;  transl.,  i.,  165. 
trausl.,  Paris,  1834,  i.,  157. 


INTRODUCTION.  Vli 

regulated  the  treatment  of  the  sick  according  to  written  pre- 
cepts, collected  and  transmitted  by  the  most  celebrated  of  their 
predecessors.  If,  in  following  exactly  these  precepts  which  are 
contained  in  the  sacred  books,  they  did  not  succeed  in  curing 
the  sick,  they  could  not  be  reproached,  nor  could  they  be  prose- 
cuted at  law ;  but  if  they  have  proceeded  contrary  to  the  text  of 
the  books,  they  are  tried,  and  may  be  condemned  to  death,  the 
legislator  supposing  that  but  few  persons  will  ever  be  found 
capable  of  improving  a  curative  method  preserved  during  so 
long  a  succession  of  years  and  adopted  by  the  most  expert  mas- 
ters of  the  art. "  With  the  system  of  legal  trial  in  use  among 
the  Egyptians  '  it  is  difficult  to  imagine  that  the  question  of  the 
existence  of  pregnancy  in  the  one  case,  or  of  malpractice  in  the 
other,  would  not  be  the  subject  of  contest,  and,  if  contested, 
determined  without  the  testimony  of  obstetricians  or  of  physi- 
cians." 

Medical  knowledge  among  the  Hindoos  was  further  advanced 
than  among  the  Egyptians.  In  the  Rig  Veda  (about  1500  B.C.) 
occur  a  few  medical  references,  among  which  is  the  statement 
that  the  duration  of  pregnancy  is  ten  (lunar)  months. 

The  earliest  purely  medical  Sanskrit  texts  are  the  Ayur 
Vedas  of  Charaka  and  Susruta,  which  were  probably  written 
about  600  B.C.,  but  which  are  undoubtedly  compilations  of  in- 
formation which  had  been  handed  down  during  many  centuries 
before  that  time.  In  each  of  these  is  a  section  devoted  to 
poisons  and  their  antidotes  (Kalpa) ,  in  which  it  is  written  that 
a  knowledge  of  poisons  and  antidotes  is  necessary  to  the  physi- 
cian "  because  the  enemies  of  the  Rajah,  bad  women,  and  un- 
grateful servants  sometimes  mix  poison  with  the  food."  Full 
directions  are  also  given  for  the  recognition  of  a  person  who 
gives  poison,  and  to  differentiate  the  poisons  themselves,  whose 
number,  from  all  the  kingdoms  of  nature,  is  legion.  The  age 
at  which  women  may  marry  is  fixed  at  twelve  years,  while  men 

'  Z,.  c,  I.,  ii.,  75,  76;  transl. ,  i.,  scriptions  of    remedies,    and  their 

153.  uses,  inchidinK  the  incantations  to 

^  The  "Papyros  Ebers, "  in  the  be  used  with  them.  (See"Papyros 
University  of  Leipzig,  the  most  Ebers, "  H.  Joachim,  Berlin.  1890.) 
ancient  medical  text  known,  was  The  same  is  true  of  the  Berlin  and 
written  about  1550  B.C. ,  and  is prob-  Leyden  papyri.  The  Bibl.  Nat. 
ably  one  of  the  books  referred  to  by  (Tf.  2)  possesses  a  Chinese  manu- 
Diodorus.  It  contains  no  statement  script  on  legal  medicine.  The  cat- 
bearing  upon  our  subject.  It  is,  alogue  does  not,  however,  state  to 
however,  simply  a  collection  of  de-  what  period  it  belongs. 


Vlll  INTRODUCTION. 

may  not  marry  before  twenty -five.  The  duration  of  pregnancy 
is  ^iven  as  between  nine  and  twelve  lunar  months,  the  average 
being  ten.  The  practice  of  medicine  is  restricted  to  certain 
castes,  and  requires  the  sanction  of  the  Rajah,  and  the  method 
of  education  of  medical  students  is  prescribed.' 

It  is  singular  that  the  Greeks  were  apparently  destitute  of 
any  knowledge  of  legal  medicine.  Although  medicine  and 
jurisprudence  were  highly  developed  among  them,  allusions  to 
anj'  connection  between  the  two  are  of  very  rare  occurrence  and 
uncertain. 

The  Hippocratic  writings  (ca.  420  B.C.)  contain  many  facts 
which  are  of  medico-legal  interest :  the  possibility  of  superfce- 
tation  was  recognized ;  '^  the  average  duration  of  pregnancy  was 
known,  and  the  viability  of  children  born  before  term  was 
discussed,^  the  relative  fatality  of  wounds  affecting  different 
parts  of  the  body  was  considered,^  and  the  Hippocratic  oath 
makes  the  physician  swear  that  he  "  will  not  administer  or 
advise  the  use  of  poison,  nor  contribute  to  an  abortion."  The 
position  of  the  physician  in  Greek  communities  was  an  exalted 
one.  No  slave  or  woman  might  be  taught  medicine,^  although 
later  free-born  women  were  permitted  to  practise  in  their 
native  places.  Homer  also  refers  to  physicians  as  men  of 
learning  and  of  distinction."  The  Greek  physician  was  there- 
fore in  a  position,  both  from  his  information  and  from  his 
standing  in  the  community,  to  aid  in  the  administration  of 
justice. 

The  Greeks  were  also  extremely  litigious  and  possessed  a 
code  of  criminal  procedure  which  was  elaborate,  and  in  many 
respects  resembled  those  now  in  use  in  England  and  the  United 
States."  The  writings  of  the  Greek  orators,  Demosthenes,  JEs- 
chines,  Lysias,  Antiphon,  Isocrates,  etc.,  which  have  comedown 
to  us  substantiate  the  claim  of  ^lian  that  "  to  Athens  mankind 

'  For  an  account  of  early  Indian  partu, "    ed.    Littre,  viii.,   432,  436, 

medicine,   see    Th.  A.   Wise,   "Re-  452. 

view  of  the  Hist,  of  Med.,"  Lond.,  *  "Aphorism i,"  \i.,    18,    24;  "De 

1867,    i.,   272    et  passim:     "Hindu  Morbis,"  ed.  Littre,  vi.,  144. 

System  of  Medicine,"  1845,  by  the  ^  petit,  S. :  "Leges Attica?, "  Lugd. 

same  author:   Haeser,    "Lehrb.    d.  Bat.,  1742,  lib.  iii.,  tit.  8. 

Gesch.  d.  Med.,"  3.  ed.,  i.,  5-40.  «  "Od.,"  iv.,  229;  xvii.,  384. 

-  Hippocr.  :  "  De  Superf  cetatione, "  '  For  an  excellent  account  of  Attic 

ed.  Littre,  viii.,  472.  criminal  procedure,  see   Kennedy, 

"Hippocr.:       "  De       Septimestri  C.    R.  :    "Demosthenes'    Orations," 

partu:"      Ibid.,      "De    Octimestri  ed.  Bohn,  iii.,  326-372. 


INTRODUCTION.  IX 

is  indebted  for  the  olive,  the  fig,  and  the  administration  of 
justice."  ' 

The  writings  of  the  Greek  physicians  contain  no  refeience 
to  any  legal  application  of  their  knowledge,  and  certain  passages 
in  the  writings  of  the  orators  seem  to  indicate  that,  while  a 
phj'sician  was  called  to  inspect  and  treat  a  wounded  person,  the 
testimony  as  to  the  patient's  condition  was  given  in  court  by 
others. 

Thus  in  the  case  against  Euergos  and  Mnesibulus,  in  which 
an  old  woman  had  died  some  dajs  after  an  assault,  Demos- 
thenes ^  states  that  he  notified  the  accused  to  bring  a  surgeon 
and  cure  the  woman ;  but  that  as  they  did  not  do  so,  he  himself 
brought  his  own  surgeon  and  showed  him  her  condition  in  the 
presence  of  witnesses.  Upon  hearing  from  the  surgeon  that 
the  woman  was  in  a  hopeless  condition,  he  again  explained  her 
state  to  the  accused  and  required  them  to  find  medical  aid. 
Finally,  on  the  sixth  day  after  the  assault  the  woman  died.  He 
further  asserts  that  these  statements  would  be  proved  by  the 
depositions.' 

The  third  Tetralogy  of  Antiphon'  (B.C.  480)  relates  to  a 
case  in  which  the  defence  was  essentially  the  same  as  that  which 
was  the  subject  of  a  vast  amount  of  medical  expert  testimony 
in  a  celebrated  trial  for  murder  in  New  York  not  many  years 
ago.  A  person  wounds  another,  who  dies  some  days  afterward. 
The  assailant  is  accused  of  murder  and  sets  up  the  defence  that 
the  deceased  perished,  not  from  the  wounds  inflicted,  but  in 
consequence  of  unskilful  treatment  by  the  physicians. 

In  neither  of  these  cases  is  any  mention  made  of  physicians 
having  been  called  upon  for  testimony ;  indeed,  the  statements 
would  lead  to  the  inference  that  they  were  not.  In  another  case 
in  which  a  poor  and  sick  citizen  is  accused  of  malingering  to 
obtain  the  customary  pecuniary  aid  from  the  State,  Lysias^ 
summons  no  medical  evidence  but  relies  entirelj*  upon  a  state- 
ment of  his  client's  case.* 

'  "  Var.  Hist.,"  iii.,  38.  at  a  preliminary  trial,  and  referred 

^Kennedy's    transl.,    ed.    Bohn,  to  at  the  trial  by  the  orator. 

v..  95.  -"Oratores    Attici,"    C.    Miiller, 

^  What  the  contents  of  these  depo-  Paris,  1877,  i.,  20. 

sitions  were  and  by  whom  made  is  -  "Oratores  Attici,  "C.  Miiller,  ed. 

unknown,  as  the  papers  referred  to  Didot,  Paris.  1877,  i.,  200-203. 

by  the  orator  are  not  given.     In  the  "  In  a  doubtful  fragment  of  Lysias 

Attic  courts  the  testimony  was  taken  the  expression  "as  physicians  and 


X  INTRODUCTION. 

Medical  legislation  was  not  more  advanced  during  the  as- 
cendancy of  the  Roman  Empire,  although  medical  science  was 
greatly  developed,  principally  by  the  labors  of  Celsus,  and  of 
Galen  and  other  Greek  physicians.  A  few  cases  are  mentioned 
by  the  historians  which  would  seem  to  indicate  a  closer  connec- 
tion between  law  and  medicine  than  had  existed  among  the 
Greeks,  but  the}'  refer  rather  to  the  custom  of  exposing  the 
bodies  of  those  who  had  died  by  violent  means  to  public  view, 
in  order  that  any  one  might  express  his  opinion  as  to  the  cause 
of  death,  than  to  any  appeal  to  medical  science  in  the  adminis- 
tration of  justice.  Thus  Suetonius '  sajs  that  the  physician 
Antistius  examined  the  dead  body  of  Julius  Caesar  (b.c.  44), 
and  declared  that  of  all  the  wounds  only  that  received  in  the 
breast  was  mortal. 

Pliny  ^  cites  an  early  instance  of  contested  interpretation  of 
post-mortem  appearances  in  the  case  of  Germanicus,  who  died 
A.D.  19,  by  the  action  of  poison,  said  the  enemies  of  Piso,  be- 
cause the  heart  did  not  burn.  The  friends  of  Piso,  while  ad- 
mitting the  fact  of  non-consumption,  attributed  it  to  the  de- 
ceased having  had  heart  disease.  The  same  author^  quotes 
Masurius  as  having  declared  a  child  born  after  thirteen  (lunar) 
months  to  be  legitimate,  in  an  action  for  the  possession  of 
property,  on  the  ground  that  no  certain  period  of  gestation  was 
fixed.  The  Emperor  Hadrian  (a.d.  117-138),  according  to 
Gellius,  sought  medical  information  in  a  similar  case,  and 
decreed  the  legitimac}'  of  a  child  born  in  the  eleventh  (lunar) 
month,  "  after  having  considered  the  opinions  of  ancient  philos- 
ophers and  physicians." ' 

Although  the  Justinian  collections,  the  "Codex"  (a.d.  529), 
the  "Institutes"  (a.d.  533),  the  "Digests,"  or  "Pandects"  (a.d. 
534),  and  the  "Novels"  (a.d.  535-564),  prepared  by  the  best  legal 
talent  of  the  age,  under  the  direction  of  Tribonian,  do  not  pro- 
vide for  the  summoning  of  physicians  as  witnesses ;  they  con- 
tain an  expression  which  indicates  that  at  that  time  the  true 

midwives  declare"  {uffTrepollarpolKal  -  "Hist.  Nat.,"  xi.,  71. 

al  fialat  a-eprjvavro)    is   used  in  con-  *"Hist.  Nat.,"vii.,  4. 

nection  with  the  question  whether  •*  A.    Gellius:  "Noct.  Att. ,"  1.   3, 

a  foetus  has  life  and  maybe  niur-  c.  16:  "requisitis  veterum  philoso- 

dered.     Cf.   "Orat.  Attici,"  Miiller  phorum  et  medicorum  sententiis." 

and  Hunziker,   Paris,    Didot,  1858,  The  word  "  refer2a?i"  seems  to  indi- 

ii.,  257.  cate  that    the    emperor    consulted 

^  "Jul.  Cses.,"  82.  books,  not  living  physicians. 


INTRODUCTION.  XI 

function  of  the  medical  expert  was  more  correctly  appreciated 
than  it  is  to-day.  His  function  was  stated  to  be  judicial  rather 
than  that  of  a  witness.'  There  is  also  a  provision  that  in  cases 
of  contested  pregnane}',  midwives  (who  were  considered  as  be- 
longing to  the  medical  profession)  should,  after  examination  of 
the  woman,  determine  whether  or  no  pregnancy  exist,  and  that 
their  determination  should  be  final.  The  practice  of  medicine, 
surgery,  and  midwifery  was  regulated.  Those  desiring  to 
practise  must  have  been  found  competent  by  an  examination. 
The  number  of  phj^sicians  in  each  town  was  limited.  They 
were  divided  into  classes,  and  were  subject  to  the  government 
of  the  Archiatri.  Penalties  were  imposed  upon  those  guilt}'  of 
malpractice  or  of  poisoning.  The  Justinian  enactments  contain 
abundant  internal  evidence  of  having  been  framed  in  the  light 
of  medical  knowledge.  They  contain  provisions  relating  to 
sterility  and  impotence,  rape,  disputed  pregnancy,  legitimacy, 
diseased  mental  conditions,  presumption  of  survivorship,  poi- 
soning, etc.,  which  indicate  that  the  medical  knowledge  of  the 
time  was  fully  utilized  in  their  construction." 

The  Germanic  peoples  at  about  the  same  period  possessed 
codes  in  which  traces  of  a  rudimentary  inedical  jurisprudence 
existed.  The  most  ancient  of  these  was  the  Salic  law  (a.d. 
422),  in  which  the  penalties  to  be  paid  for  wounds  of  different 
kinds  are  fixed.  The  Ripuarian  law,  of  somewhat  later  date, 
takes  cognizance  of  the  crime  of  poisoning.  The  laws  of  the 
Bavarians,  Burgundians,  Frisians,  Thuringians,  and  Visigoths 
contain  practically  nothing  of  medico-legal  interest.  The  Lex 
Alamannorum  has  numerous  provisions  relating  to  wounds,  and 
expressly  provides  that  the  gravity  of  the  injury  shall  be  deter- 
mined by  a  phj'sician.^ 

During  the  period  of  about  a,  thousand  years,  intervening 
between  the  Justinian  and  Caroline  (vide  infra)  codes,  the 
advancement  of  medicine  and  jurisprudence  suffered  almost 
complete  arrest.     The  guilt  or  innocence  of  an  accused  person 

'  " Medici non sunt  proprie  testes,  burg.  1838:  M.  F.  Eller.  Bull.  Med.- 

sed  majis  est  judicium  quam  testi-  Leg.  Soc.   N.  Y.,    1879.  i.,  220-287; 

moniuni."'  and  Friedi'eich.  Bit   f.  ger.  Anthr., 

-  For  accounts  of  the  medico-legal  Niirnberg,  1850,  I.,  iii.,  1-64;  18(52, 

provisions  of  the  Justinian  enact-  xiii.,  188-215. 

ments,    see:   G.  A.  v.  d.   Pfordten,  ^  See   Mende :    "Handb.    d.    ger. 

"Beitriige  z.  Gesch.  d.   ger.   Med.  Med.."  Leipzig,  1819,  i.,  83-87. 
riKs  d.   Justin.  Rechtssam.,"  "Wiirz- 


Xll  INTRODUCTION. 

was  determined  rather  by  his  own  confession  under  torture,  or 
by  "  the  judgment  of  God"  as  shown  by  ordeal  or  by  judicial 
combat,  than  by  testimony  either  expert  or  of  fact. 

Even  during  the  night  of  the  Middle  Ages,  instances  are 
recorded  in  which  the  opinions  of  phj-^sicians  were  sought  to 
determine  questions  of  fact  in  judicial  proceedings. 

In  the  duchy  of  Normandy,  in  1207-45,  the  laws  provided 
for  the  examination  of  those  claiming  to  be  sick  (to  evade 
military  service  or  appeal  to  judicial  duel),  of  persons  killed, 
and  of  women.' 

In  a  decretal  of  Innocent  III.,  in  1209,  the  question  whether 
a  certain  wound  was  mortal  was  determined  b}-  phj'siciaus.' 

There  is  extant  in  the  statutes  of  the  city  of  Bologna,  under 
date  of  12-49,  an  entry  to  the  effect  that  Hugo  di  Lucca  had 
been  assigned  the  duty,  when  called  upon  by  the  podesta,  and 
after  having  been  sworn,  to  furnish  a  true  report  in  legal  cases. ^ 

In  the  kingdom  of  Jerusalem  (ca.  1250)  a  person  claiming 
exemption  from  trial  by  battle  because  of  sickness  or  of  wounds 
was  visited  by  a  physician  {fisicien  au  miege)  and  a  surgeon 
[serorgien) ,  who  examined  him  and  made  oath  as  to  his  con- 
dition.' 

Sworn  surgeons  to  the  king  are  also  mentioned  in  letters 
patent  of  Philippe  le  Hardi  in  12T8,  of  Philippe  le  Bel  in  1311, 
and  of  Jean  II.  in  1352.'  That  of  Philippe  le  Bel  refers  to  Jean 
Pitardi  as  one  of  "  his  well- beloved  sworn  surgeons  in  his 
Chastelet  of  Paris,"  whose  functions  are  partly  indicated  by 
the  extracts  from  the  registers  given  below. 

The  registers  of  the  Chatelet  at  Paris  from  1389  to  1393 
record  several  instances  in  which  medical  aid  was  rendered  in 
judicial  proceedings.  Under  date  of  March  22d,  1389-90, 
*'Maitre  Jehan  Le  Conte,  sworn  surgeon  to  the  king  our  sire," 
reports  to  Maitre  Jehan  Truquam,  lieutenant  to  the  provost, 
that  "  upon  that  daj'  in  the  morning  one  Rotisseur  had  gone 

'  ■'  Etablissements    et   Coutuines.  fuisse  letalis, "  Mende,   "  Handb.  d. 

Assises  et  Arrets  de  I'Echiquier  de  ger.  Med.,"  i.,  91. 

Normandie  au   xiii.  Siecle."  A.  J.  ^  Hensschel.  in  "  Janus, "  Breslau, 

Marnier, Par.,  1839  :  "veued'homme  1847,  ii.,  135. 

en  langueur,  veue  de  mefaits.  veue  *  "  Assises    de    Jerusalem, "   Beu- 

d'homme  occis  et  veue  de  femme  gnot.  Paris,  1841-43,  quoted  by  Orto- 

despucelee. "  Ian.  I.e.,  infra. 

'-'"Ut  peritorum  judicio  medico-  *  Ortolan :    ''Debuts    d.    1.    Med. 

rum  talis  percussio  asseveretur  non  leg.,"  Ann.    d'Hjg. .    Par.,  1872,   2 

s. ,  xxxviii. ,  361. 


INTRODUCTION.  xiii 

from  life  unto  death  in  consequence  of  the  wounds  which  he 
had  received  on  the  Monday  evening  preceding."  '  Under  date 
of  July^2d,  1390,  is  an  account  of  the  examination  of  one  Jehan 
le  Porchier,  accused  of  intent  to  poison  the  king  (Charles  VI.), 
in  which  there  is  reference  to  a  very  early  instance  of  toxicologi- 
cal  expert  evidence.  In  the  wallet  of  the  accused  certain  herbs 
were  found.  The  account  proceeds:  "Richart  de  Bules,  herb- 
alist, was  summoned,  to  him  the  above-mentioned  herbs  were 
shown,  and  he  was  commanded  that  he  should  examine  them 
and  consider  well  and  dul}^,  reporting  the  truth  of  what  he 
should  find.  The  said  Richart,  after  having  examined  them 
with  great  diligence,  reported  that  in  the  box  in  which  these 
herbs  were  he  had  found  six  leaves,  namely :  one  leaf  of  jacia 
nigra,  and  one  of  round  plantain,  called  in  Latin  p^antago 
mitior,  and  four  of  sow-thistle  {lasseron),  called  in  Latin  rosti 
poterugni,  and  says  that  the  leaf  oijatria  nigra  is  poisonous, 
but  that  in  the  others  there  is  no  poison  known  to  the  depo- 
nent."'^ On  August  12th,  1390,  "Jehan  Le  Conte  and  Jehan 
Le  Grant,  sworn  surgeons  of  our  sire  the  king,"  are  present  at 
the  torture  of  a  prisoner,  but  for  what  purpose  does  not  appear. 
In  another  case  the  same  Jehan  Le  Conte  testified  that  a  wound 
in  the  head  of  a  deceased  person  was  made  with  an  axe.^  At  a 
later  period  in  Ital}',  the  infliction  of  "  the  question"  took  place 
under  medical  supervision.  Zacchias  devotes  a  chapter,  De 
Tormentis  et  Poenis,*  to  the  consideration  of  the  different 
methods  of  torture,  the  degrees  of  pain  and  danger  attending 
each,  and  the  conditions  of  age,  sex,  and  health  which  render  its 
application  inadmissible.^ 

During  this  period,  as  indeed  from  the  earliest  times,  the 
practice  of  medicine  was  regulated  hj  law.  Thus  a  law  of  King 
Roger  of  Sicily  (1129-54)  punished  those  who  practised  med- 
icine without  authority  with  imprisonment  and  confiscation  of 
goods;  and  an  edict  of  Frederick  II.  (1215-46)  imposed  like 
penalties  upon  those  who  presumed  to  practise  except  after 
graduation  at  the  school  of  Salernum.* 

■  "Registre  Criminel  du  Chatelet  ^  See  also  "Reg.  Crim.    Chat,    de 

de  Paris, "  Par. ,  1861,  i.,  255.  Paris.,"  i.,  204.  ii..  429:  Desmaze  : 

-  Ibid.,  i.,  313.  "Hist.  Med.  Leg.,"  11-20.  33-41. 

^Ibid.,  i.,  375,  409.  « Isensee :   "Gesch.  d.  Med.,"  i.. 

^"Quajst.   Medico-Iegales,"t.  ii.,  316. 
lib.  vi.,  tit.  ii.  ;  vol.  ii.,  pp.  33-49, 
ed.  Venet.,  fol.,  1737. 


XIV  INTRODUCTION. 

Medico-legal  science  was  formed  in  the  middle  of  the  six- 
teenth century  by  a  simultaneous  awakening  of  jurists  and 
physicians  to  the  importance  of  the  subject. 

It  was  in  Germany  that  expert  medical  testimony  was  first 
legally  recognized.  In  1507,  George,  Bishop  of  Bamberg,  pro- 
claimed a  criminal  code  in  his  domains.  This  was  subse- 
quently adopted  by  other  German  states,  and  finally  was  the 
model  upon  which  the  Caroline  Code,  the  first  general  criminal 
code  applying-  to  the  whole  empire,  was  framed  and  proclaimed 
at  the  Diet  of  Ratisbon  in  1532.' 

These  codes,  particularly  the  Caroline,  distinctly  provide 
for  utilizing  the  testimony  of  physicians.  Wounds  are  to  be 
examined  by  surgeons  who  are  "  to  be  used  as  witnesses ;"  ^  and 
in  case  of  death  one  or  more  surgeons  are  to  "  examine  the  dead 
body  carefully  before  burial."^  Thej'  also  contain  provisions 
for  the  examination  of  women  in  cases  of  contested  delivery,  or 
suspected  infanticide ;  *  for  the  regulation  of  the  sale  of  poisons ;  * 
for  the  detection  and  punishment  of  malpractice;^  and  for  ex- 
amination into  the  mental  condition  in  cases  of  suicide  and  of 
crime.' 

An  early  work  on  the  practice  of  criminal  law,  based  on  the 
Caroline  Code,  was  published  by  the  Flemish  jurist,  Josse  de 
Damhouder,  in  1554.  It  contains  a  chapter  treating  of  the 
lethality  of  wounds,  which  should  be  determined  by  expert 
physicians  and  surgeons,^  and  describes  the  course  which  is  to 
be  pursued  in  the  judicial  examination  of  dead  bodies.  This 
is  probably  the  earliest  printed  book  (other  than  the  laws  them- 
selves) containing  reference  to  medico-legal  examinations,^  and 
antedates  the  writings  of  physicians  upon  the  subject. 

Although  it  was  only  in  1670  that  the  Ordinances  of  Louis 
XIV.  gave  to  France  a  uniform  criminal  code,  medico-legal 
reports  were  made  by  physicians  and  surgeons  to  the  courts 

'  "Constitutio     criminalis    Caro-  ^  "Con.  cr.  Car.,"  art.  37. 
lina."     The  first  edition  was  printed  " /6«d.,  art.  134. 
atMayence,  1533,  fol.,  by  J.  Schof-  ''Ibid.,  arts.  135,   179,  219. 
fer.      See  also   Kopp,    "Jahrb.    d.  ^"Non  perquoslibet,  uecper  insi- 
Staatsarznk. , "    Frankf.,     1808,     i.,  pidos  et  imperitos,  sed  tantum  per 
183.  peritos  ac  doctos  medicos  aut  chi- 

•2  "Con.  cr.  Car.,"  art.  147.  rurgos,"  p.  245. 

^  Ibid.,  art.  149.  *  "Praxis  Rerum   Criminaliuni, " 

"^  Ibid.,    arts.    35.     36,     131,    133;  Antw.,    1554  (the   dedicatory   epis- 

"  Bambergische     Halssgerichts-Or-  tie    is   dated    1551),    pp.    245-252, 

denung,"  Bamb.,  1507,  art.  44.  223-228. 


INTRODUCTION.  XV 

more  than  a  century  before.  Indeed,  the  earliest  medico-legal 
work  written  by  a  physician '  is  the  27th  book  of  the  QEuvres 
d'Ambroise  Pare,  first  printed  in  1575,  in  which  he  directs  the 
forms  in  which  judicial  reports  shall  be  made  in  various 
medico-legal  cases."  During  the  remainder  of  the  sixteenth 
centurj'  France  produced  but  three  treatises  on  medico-legal 
subjects.^  One  of  these,  written  by  the  jurist  A.  Hotman, 
distinctly  mentions  the  employment  of  physicians  to  determine 
questions  of  fact. 

In  Italy  works  on  medical  jurisprudence  were  published  at 
the  close  of  the  sixteenth  and  beginning  of  the  seventeenth  cen- 
tury. The  earliest  of  these  was  a  chapter  of  Codronchius, 
treating  of  the  "method  of  testifying  in  medical  cases,''  in 
1597.^  At  about  the  same  time,  but  certainly  later,  appeared 
the  work  of  Fortunatus  Fidelis,  to  whom  the  honor  of  being 
the  first  writer  on  medical  jurisprudence  is  given  by  many.^ 

The  great  work  of  Paulus  Zacchias,  physician  to  Pope  Inno- 
cent X.,  was  first  printed  at  Rome,  1621-35.  This  medico- 
legal classic  contains  in  the  first  two  volumes  the  "  Qiicestiones" 
and  in  the  third  the  decisions  of  the  Roman  Rota,     It  treats  of 

'  Wildberg,     "Bibl.     Med. -for.,"  printed    in    1562,    Pare  is   referred 

Berl.,    1819,    Nos.    553,    554,    1,124,  to  as  "chirurgien  ordinaire  du  Roi, 

1,125,     1,126,     1,304,    1,835,     1,836.  et  Jure  a  Paris. "     Ploucquet,  "Lib. 

2, 342,  cites  nine  works  earlier  than  Med.    dig.,"  Tiib. ,    1809,    iv.,    349, 

1575.      Tliese  are,   however,  mono-  mentions  a  monograph  by  "Tygeon, 

graphs  on  the  period  of  gestation,  Th. , "  printed  at  Lyons,  1575. 
witchcraft,   fasting  girls,  drunken-  ^  S.  Pineau  :  "  De  notis  Integritatis 

ness,  and  wounds  of  the  head.  et  Corruptionis  Virgiuum,"  Paris, 

Works  on  toxicology  were  written  1598;  A.   Hotman:  "Dela  Dissolu- 

at  a  much  earlier  date  :  the  QiipinKa  tion  duMariagepar  I'lmpuissance," 

and  AlE^updpfima,  of  Nicander,   ca.  etc. ,  Paris,  1581  ;  delaCorde,  "Ergo 

B.C.   135;   the  T^epl  (5>/h/-?/piuv  (papfia-  Virgo  .   .   .  lac  in  mammis  habere 

«Ji,  of  Dioscorides,  ca.  A. D.  50  ;  the  potest, "  Paris,   1580.     Wildberg,  I. 

treatises,    "De  Venenis, "  of  Petrus  c. ,  Nos.   555,   1,308,    1,309,   are  not 

de    Abbano    {ca.  a.d.    1250),     first  properly  medico-legal, 
printed  Mantua,  1472;  of  Arnoldus  •'In   his  "De  Vitiis  Vocis, "  etc., 

da  Villanova  {ca.  a.d.   1300),  first  Frankf. ,  1597.     He  had  previously 

printed   {sine  loc.   et  an.)    ca.  1470 ;  published  a  treatise,    "De    morbis 

of  Santes  deArdoynis,  Venice,  1492,  veneficis     ac    veneficiis, "    Venet. , 

and  of   F.  Ponzetti,   Venice,    1492,  1595. 

are  among  the  earliest.     Works  on  ''"De     relationibus     medicorum 

toxicology  are    not   considered    in  ...    in   quibus   ea   omnia  (juie   in 

this     Introduction,    the     historical  forensibusac  publicis  causis  luediri 

sketch  of  that  science  being  reserved  referre     solent. "      etc. ,     Panorm  i . 

for  a  later  voluine.  1603.       Mongitore,      "  Bibl.     Sic. , " 

-Ed.  Malgaigne,   1840,  t.  iii.,    1.  Panormi,  1707-14.  i..  199,  mentions 

xxvii.,    pp.     651-658;    ed.     princ,  an  edition  of  1598,  Pan.,  under  tlie 

Paris,    1575,    fob,  pp.   931-944.     On  title  :  "Bissus  [Birrus?],  sive  med- 

the  title-page  of  an  earlier  work,  icoruni  patrocinium, "  etc. 


XVI  INTRODUCTION. 

every  branch  of  medico-legal  science,  and  discusses  physiologi- 
cal questions  of  legal  interest,  besides  dealing  with  questions 
such  as  the  infliction  of  torture  and  miracles.' 

Although  the  "  Qusestiones  Medico-legales"  of  Zacchias  was 
the  first  systematic  work  upon  medical  jurisprudence,  his  coun- 
trymen in  succeeding  centuries  have  contributed  but  little  to 
this  science.  It  is  only  during  the  latter  part  of  the  present 
century  that  Italians  have  again  become  prominent  in  medico- 
legal literature. 

In  France  legal  medicine  progressed  but  little  from  the  time 
of  Pare  to  the  latter  part  of  the  eighteenth  century.  Several 
treatises  appeared,  being  chiefly  upon  legitimacy  and  kindred 
subjects,^  with  a  few  treating  of  reports,  signs  of  death,  etc' 

Toward  the  end  of  the  eighteenth  century  the  labors  of 
Louis,  Petit,  Chaussier,  and  Fodere  elevated  legal  medicine  to 
the  rank  of  a  science.  The  investigations  of  Louis  (Ant.  L.) 
were  numerous  and  important  in  this  as  in  other  subjects,^  and 
the  "  causes  celebres"  contain  reports  of  many  trials  in  which  he 
threw  light  upon  doubtful  medical  questions.^  Antoine  Petit, 
a  contemporary  of  Louis,  contributed  an  extensive  work  on  the 
duration  of  pregnancy  as  affecting  legitimac5\ '' 

Somewhat  later  Fr.  B.  Chaussier,  between  1785  and  1828, 
published  at  Dijon  a  number  of  treatises  on  infanticide,  viabil- 
ity, surgical  malpractice,  etc'  Fodere,  a  Savoyard,  was  the 
first  to  publish  a  systematic  treatise  on  medical  jurisprudence 
in  France,  which  was  first  printed  in  1798  and  in  a  much  en- 

'  "Qusestiones      Medico-legales,"  murder  by  hanging,   1763;  on  the 

Rome,   1612-35,   3  t.,  fol.     See  also  duration    of    pregnancy,  1764,  etc. 

Kerscliensteiner  ;  Friedr.  Bl.  f.  ger.  These  and  other  articles  on  drown- 

Med. ,    etc.,    Niirnb.,   1884,  'xxxv. ,  ing,    etc.,     are     collected     in     his 

401-410.  "(Euvres  diverses  de  Chirurgie, '"  3 

sWildberg,     "Bibl.     Med. -for.,"  vols..  Par.,  1788. 

gives  the  titles  of  thirty-four  trea-  ^  Cases     of     Monbailly,    Syrven, 

tises    on     legitimacy,     impotence,  Galas,  Cassaigneux,  Baronet,  etc. 

sterility,   signs  of    virginity,   etc.,  ^  "Hecueil  de  pieces  relatives  a  la 

published    in    France    during  this  question  des  naissances  tardives," 

period.  Amst.  and  Par. ,  1766,  2  vols. 

3  On  reports:  Rene  Gendri,  1650;  ^  "Consult.  Med. -leg.  s.  u.  Accus. 

Nicolas deBlegny,  1684;  J.  Devaux,  d'Infanticide, "  1785;  "Obs.   Chir.- 

1693;  Prevot,   1753;    H.   M.   Maret,  leg.,"     1790;     "Med. -leg.,"     1809; 

1757.     On    signs  of   death:    P.   E.  "Consult,  et  Rapp.  surd i verses obj. 

Dionis,  1718  ;  J.  B.  Winslow,  1740;  d.   Med. -leg.,"  1824;  "Mem.  med.- 

S.  J.  Bruhier,  1745.  leg.  s.  1.  Viabilite, "  1826  :  "  Consult. 

^  On  the  signs  of  death,  1752;  on  Med. -leg.  s.    u.    cas    d'amp.     d.    1. 

the  distinction  between  suicide  and  Cuisse, "  1828. 


INTRODUCTION.  XVll 

larged  form  in  1S13.'  This  last  edition  is  an  exhaustive  treatise 
upon  all  branches  of  legal  medicine  and  public  hygiene,  and 
won  for  its  author  the  appointment  as  Professor  of  Forensic 
Medicine  in  the  University  of  Strassburg. 

At  about  the  same  period  appeared  the  works  of  Mahon' 
and  of  Belloc, "  both  of  which  went  through  three  editions  in  ten 
years,  and  those  of  Biess3^' 

The  most  industrious  and  original  of  French  professors  of 
legal  medicine  was  Orfila.  A  native  of  Minorca,  he  graduated 
in  medicine  at  Paris  in  1811,  and  devoting  himself  to  chemical 
and  toxicological  investigations,  published  the  first  edition  of 
his  "  Traite  des  Poisons"  in  1814.  This  work,  which  may  be 
regarded  as  the  foundation  of  experimental  and  forensic  toxi- 
cology, went  through  five  editions  to  1852,  and  was  translated 
into  sevei-al  foreign  languages.  The  first  edition  of  his  "  Legons 
de  Medecine  legale"  appeared  in  1821,  and  the  fovirth  in  1848. 
Besides  these  Orfila  published  a  work  on  the  treatment  of 
asphyxia  and  a  great  number  of  papers  on  medico-legal  subjects, 
principally  in  the  Annales  cV Hygiene,  of  which  he  was  one  of 
the  founders  with  Andral,  Esquirol,  Leuret,  and  Devergie. 
Orfila  occupied  the  chair  of  chemistry  and  medical  jurispru- 
dence in  the  University  of  Paris  for  upward  of  thirty  years,  and 
was  employed  as  expert  in  innumerable  cases  before  the  courts. 

Contemporaneous  with  Orfila,  and  almost  as  prominent,  was 
Devergie,  the  first  edition  of  whose  "Medecine  legale,"  in  three 
volumes,  appeared  in  1836,  and  the  third  in  1852. 

In  1820  the  first  edition  of  the  Manual  of  Briand  and  Bros- 
son  was  published.  This  work,  the  tenth  edition  of  which  was 
published  in  1879,  is  the  first  in  which  a  jurist  was  associated 
with  a  phj'sician  in  the  authorship, '"  and  is  one  of  five  of  which 
one  of  the  authors  is  a  lawyer." 

'"Les  Lois  eclairees  par  les  Sci-  *  lu  the  later  editions  Chaude  took 

ences  physiques, "  Par. ,  1798,  3  vols.,  the  place  of  Brosson,  and  a  chemist, 

8vo  ;  "Traite  de  Med. -leg.  etd'Hyg.  J.  Bonis,  was  added, 

puhl.,"  Par.,  1813,  6  vols.,  8vo.  «  Devergie,      "Med. -leg.,"     1836, 

■^  "Med. -leg. ,"  etc.,  Rouen,  1801;  contains    a    legal    chapter    by    de 

Paris,  1807,  1811.  Robecourt.     Paris  and  Fonblanque, 

■'"Cours.   de   Med. -leg. ,"     Paris,  "Med.      Jurispr. ,"     Lond.,      1823; 

1809,1811,  1819.  Wharton  and   Stille,   "Med.   Jur.." 

•*  "  Apergu  et  obs.  s.  1.  Med. -leg. ,"  Phila. ,  1855;  Le   Grand   du   Saule, 

Lyon,  1811;  "Secours  aux  Asphyx-  Berryer  et  Poucliet.  "Tr.  de  Med.- 

ies, "  Lyon,    1818;    "Man.  d.  Med.-  leg.  de  Jur.   med.    et  de  Tox.,"  2d 

leg.,"  Lyon,  1831.  ed.,  Par.,  1881. 
2 


XViil  INTRODUCTION. 

Special  treatises  on  the  medico-legal  relations  of  insanity 
were  published  by  Georget  (1821),  Falvet  (1828),  Esquirol 
(1838),  and  Marc  (1840),  and  on  midwifery  by  Capuron  (1821). 

Tardieu,  Professor  of  Legal  Medicine  in  the  University  of 
Paris  (1861-79),  published  a  most  important  series  of  mono- 
graphs on  hygienic  and  medico-legal  subjects,'  besides  man}- 
papers,  principally  in  the  Annales  d^ Hygiene,  etc.,  and  testi- 
fied before  the  courts  in  many  "  causes  celebres.'^ 

The  first  work  of  medico-legal  interest  to  appear  in  Ger- 
many was  the  "  Medicus-Politicus"  of  Rodericus  a  Castro,  a 
Portuguese  Jew  living  in  Hamburg,  printed  in  1614,  which 
deals  principally  with  medical  ethics  and  the  relations  of  physi- 
cians, but  contains  chapters  on  simulated  diseases,  poisoning, 
wounds,  drowning,  and  virginit}".'' 

It  was  only  toward  the  end  of  the  seventeenth  century  that  the 
subject  was  scientifically  treated,  and  during  the  latter  part  of  the 
seventeenth  century  and  the  beginning  of  the  eighteenth  great 
progress  was  made  in  the  development  of  forensic  medicine  in 
Germany.  Johannes  Bohn,  one  of  the  originators  of  the  experi- 
mental method  of  investigation  in  physiological  chemistry  and 
physics,  at  the  University  of  Leipzig,  was  also  one  of  the  earli- 
est German  contributors  to  the  literature  of  legal  medicine. 
Besides  smaller  works  he  published  two  noteworthy  treatises : 
in  1689  a  work  on  the  examination  of  wounds  and  the  distinc- 
tion between  ante-mortem  and  post-mortem  wounds,  and  be- 
tween death  by  injur}',  strangulation,  and  drowning.'  In  1704 
a  work  giving  rules  for  the  conduct  of  ph3'sicians  in  attending 
the  sick  and  in  giving  evidence  in  the  courts.^  At  about  the 
same  period  M.  B.  Valentini,  professor  in  the  University  of 
Giessen,  published  three  important  works,  containing  collec- 
tions of  medico-legal  cases,  and  of  the  opinions  and  decisions 

'"  Sur  les  Attentats  aux  Moeurs, "  fuit  exhibitiim  ;   cap.    xi.  :    testifi- 

1st  ed.,   1857;  7th  ed.,   1878;    "Sur  candi  ratio  Id   viilneribus  capitis; 

I'Avortement, "     1856,      1861,    1868  ;  et  in  iis  qui  aqua  fueiunt  suflFocati  ; 

"SuriaPendaison,"etc.,  1865,  1870,  cap.  xii.  :  Quomodo  amissa  virgin- 

1879;       "Sur      rEnipoisounement"  itas :     et    alterius    utrius    conjugis 

(with  Z.  Roussin),  1867,  1875  ;  "Sur  sterilitas  deprehendatur. 

rinfanticide, "  1868  ;  "Sur  laFolie, "  ^"De  renuuciatioue  vulnerum," 

1872  ;" Sur lesBlessures,"  1879;  "Sur  etc..  Lips.,  1689,    8vo  ("Egregium 

les  Maladies,  etc. , "  1879.  opus, "  Haller) . 

'-'  Lib.  iv. ,  cap.  ix.  :   Qua  ratione  •*  "De  officio  niedici  duplici,  cliu- 

morbum  siniulantes  d  e  p  r  e  h  e  n  d  i  ico  niniirum  et  foreusi,  "  Lips. ,  1704, 

queaut ;    cap.    x.  :    testiiicandi  me-  4to  ("Eximius  liber, "  Haller) . 
thodus  circa  eos,    quibus  venenum 


INTRODUCTION.  xix 

of  previous  writers. '  Another  extensive  collection  of  cases  and 
decisions  was  published  in  ITOG  by  J.  F.  Zittmann,  from  a  MS. 
left  b}^  Professor  C.  J.  Lange,  of  the  University  of  Leipzig;' 
and  still  another  b}'  J.  S.  Hasenesf*  appeared  in  1755. 

During  the  latter  part  of  the  eighteenth  century,  the  Ger- 
mans cultivated  legal  medicine  assiduousl}^  and  a  great  number 
of  works  upon  the  subject  were  published.  Among  these  may 
be  mentioned  those  of  M.  Alberti,  professor  at  the  University 
of  Halle; '  H.  F.  Teichmej-er,  of  the  University  of  Jena; '  A.  O. 
Golicke,  of  the  universities  of  Halle  and  Duisburg,  who  was 
the  first  to  prepare  a  bibliography  of  the  subject ;  °  J.  F.  Fasel 
(Faselius),  professor  at  Jena;'  J.  E.  Hebenstreit  and  C.  S. 
Ludwig,  professors  at  Leipzig;*  C.  F.  Daniel,  of  Halle;*  J. 
D.  Metzger,  professor  at  Konigsberg,  the  author  of  a  number 
of  works,  one  of  which,  a  compendium,  was  translated  into 
several  other  languages; '°  J.  V.  Mliller,  of  Frankfurt ;  "  J.  C. 
T.  Schlegel,  who  collected  a  series  of  more  than  forty  disserta- 
tions by  various  writers;'"  M.  M.  Sikora,  of  Prague;'^  J.  J. 
von  Plenck,  professor  in  Vienna,  who  published  a  work  on 
forensic  medicine  and  one  on  toxicology;"  K.  F.  Uden,  sub- 
sequenth"  professor  in  St.  Petersburg,  who  was  the  first  to 
publish  a  periodical  journal  devoted  to  legal  medicine,  Avhich 

'  "PandectfB     Medico-legales, "  '  "Elementa  Medicinfe  forensis, " 

etc..  Francof. ,  1701,  4to  ;  ''NovellEe  Jena,  1767,  published  posthumously. 

Medico-legales, "     etc.,      Francof.,  **  Hebenstreit :        "  Anthropologia 

1711,   4to ;    "'Corpus  Juris   Medico-  forensis,"    Lips.,     1753;      Ludwig: 

legale, "  etc. ,  Francof.,  1723,  fol.  "Institutiones  Medicinae  forensis," 

-  "'Medicina  forensis,  hoc  est  re-  ed.  2,  Lips.,  177-1. 

sponsa  facultatis  niedicEe  Lipsiensis  '"'Beitrage    zur     medicinischen 

ad  qua?.-itiones  et  casus medicinales,  Gelehrsamkeit, "   etc.,   Halle.   17-18- 

ab  anno  1650  usque  1700, "  Francof. ,  54;       "Samnilung      medicinischen 

1706,  2  vols. ,  4to.  .   .   .  Zeugnissen,"     etc.,       Leipz., 

^  "Der  medicinischeRichter,  oder  1776;      "  lustitutionum     Medicinae 

Acta  phvsico-medico  forensia  Col-  publicfe, "  etc.,  Lips..  1778. 

legii  medici  Onoldiui,"  Onolzbach,  '"  "  Kurzgefasstes  System  der  ge- 

1755,  4to.  richtlichen      Arznej'wissenschaf t, " 

*  "Systema  Jurisprudentiae  Med-  Konigsb.  u.  Leipz..  1793. 

icae, "  etc.,  6  vols.,  4to,  Halle,  Leip-  "  "Entwurf     der     gerichtlichen 

zig,  and  Gorlitz,  1725-47.  Arznoiwissenschaft, "  etc.,  Frankf., 

*  "Institutiones  Medicinae  legalis      1796-1801,  4  vols. 

et  forensis, "  Jena,  1723,  1731,  1740,  '- "  Collectio  Opusculorum  selecto- 

1762.  rum  ad  Mediciuain  forensem  spec- 

*  "Medicina  forensis  demonstra-  tantium,"  Lips.,  1785-90,  6  vols, 
tiva, "    etc.,     Frankf.,     ad    Viadr.,  ^^  "Conspectus* Medicina?  legalis, " 
1723;  "lutroductio  inhistoriani  lit-  etc.,  Prague,  1780. 
terariamscriptorumqui  medicinam  '■*  "Elementa  Medicinae etChirur- 
forensem  commentarius  suis   illus-  giae  forensis, "  Viennse,  1781;  "Tox- 
traverunt, "  Frankf.,  1723,  1735.  icologia, "  etc. .  Viennae,  1785. 


XX  INTRODUCTION. 

was  afterward  continued  by  J.  F.  Pyl  at  Stendal;'  and  J.  C. 
Fahner.' 

At  this  period  compends  for  students  were  published  in  Ger- 
many, which  indicate  by  their  number  the  extent  to  which  this 
science  was  the  subject  of  study.  Among  these  those  of  Ludwig 
(17G5),  Kannegieser  (1768),  von  Plenck  (1781),  Frenzel  (1791), 
Loder  (1791),  Amemann  (1793),  Metzger  (1800),  and  Roose 
may  be  mentioned. 

The  Germans  of  the  present  century  have  maintained  the 
pre-eminence  in  legal  medicine  achieved  by  their  forefathers. 
Among  a  great  number  of  investigators  and  writers  a  few  may 
be  mentioned :  C.  F.  L.  Wildberg,  professor  at  Rostock,  was  a 
most  prolific  writer,  edited  a  journal  devoted  to  state  medicine, 
and  contributed  a  valuable  bibliographj'  of  the  subject;'  A.  F. 
Hecker,  professor  at  Erfurth  and  afterward  at  Berlin,  and  J. 
H.  Kopp  each  edited  and  contributed  extensively  to  a  medico- 
legal journal."  A  much  more  important  periodical  was  estab- 
lished in  1821  by  Adolph  Henke,  professor  in  Berlin,  and  was 
continuously  published  until  1864.  Henke  also  wrote  a  great 
number  of  articles  and  a  text-book  on  legal  medicine."  Jos. 
Bernt,  professor  at  Vienna,  published  a  collection  of  cases,  a 
systematic  treatise,  and  a  number  of  monographs,"  as  well  as 
the  MS.  work  left  by  his  predecessor  in  the  chair,  F.  B.  Vietz. 
A  handbook  containing  an  excellent  history  of  medico-legal 
science  was  published  by  L.  J.  C.  Mende,  professor  at  Grief s- 
wald,'  who  also  contributed  a  number  of  monographs,  chiefly 
on  obstetrical  subjects.  K.  W.  N.  Wagner  contributed  but  lit- 
tle to  the  literature  of  the  subject,  but  it  was  chiefly  by  his 

'  Magazin    fiir    die    gerichtliche  and  1849  Wildberg  published  fifteen 

Arzneikunde  und  niedicinische  Po-  books  and  treatises  on  medico-legal 

lizei,  Stendal,  1782-87,  6  vols.     Pyl  subjects. 

also  published  "Aufsatze  und  Be-  ■»  Kritische   Jahrb.    f.    d.    Staats- 

obachtungen  aus  der  gerichtlichen  arznk.  f.   d.   xix.   Jahrh. ,    1806-09. 

Arzneiwissenschaft,  ■"  Berlin,   1783-  Jahrb.  d.  Staatsarznk. ,  1808-19. 

9.3,    8  vols.     Uden  was  the  first  to  ^  Zeitschrift  fiir  die  Staatsarznei- 

edit  a  medical  journal  in  Russia.  kunde,  Erlangen,  1821-64,  118  vols.  ; 

2  "Vollstandiges  System  der  ge-  "Lehrbuchderger.  Med.,"  Ite  Aufl., 

richtlichen  Arzneykunde, "  Stendal,  Berlin,    1812,    13te    Aufl. ,    Berlin, 

1795-1800:     ^'Beitrage    zur    prakti-  1859. 

schen    und    gerichtlichen    Arznei-  «  "Visa  Reperta,"  Wien.  1827-45, 

kunde,"  Stendal.  1799.  3  vols.  ;  "Systematisches  Handb.  d. 

■  Jahrb.  der  gesam.  Staatsarznei-  ger.  Med.,"  Wien,  Ite  Aufl.,   1813, 

kunde.    Leipzig,    1835-40,    7    vols.;  5teAufl. ,  1846. 

•  Bibliotheca   Medicinte    publicje."  '  "Ausfiihrl.      Handb.      d.     ger. 

Berol.,  1819,  2  vols.     Between  1804  Med.,"  Leipzig,  1819-32,  6  vols. 


INTRODUCTION.  xxi 

efforts,  while  professor  in  the  University  of  Berlin,  that  a 
department  for  instruction  in  state  medicine  was  established 
there  in  1832.  A.  H.  Nicolai,  also  professor  at  Berlin,  pub- 
lished a  handbook '  besides  numerous  articles  in  the  journals. 
F.  J.  Siebenhaar  published  an  encyclopsBdia  of  legal  medicine, 
and  in  1842  established  a  journal  devoted  to  state  medicine, 
which  in  its  continuations  was  published  until  1872."  J.  B. 
Friedreich,  professor  at  Erlangen,  after  editing  a  journal  de- 
voted to  state  medicine  from  1844  to  1849,  established  one  of 
the  most  important  of  current  medico-legal  periodicals  in  1850,^ 
to  both  of  which  he  was  a  frequent  contributor  until  his  death 
in  1862.  Ludwig  Choulant,  professor  at  Dresden,  and  more 
widely  known  as  the  author  of  important  contributions  to  the 
history  of  medicine,  published  two  series  of  reports  of  medico- 
legal investigations." 

The  foremost  forensic  physician  of  this  period  in  Germany 
was  unquestionably  John  Ludwig  Casper,  professor  in  the 
University  of  Berlin  and  "forensic  physician"  (gerichtlicher 
Physicus)  to  that  city,  who  greatly  extended  the  department 
established  in  the  university  under  Wagner.  He  made  in- 
numerable investigations,  some  of  which  are  preserved  in  sev- 
eral collections  of  cases, '^  others  in  his  classic  Handbook,"  and 
still  others  in  the  periodical  which  he  established  in  1852,  and 
which  is  now  the  most  important  current  medico-legal  journal.' 

It  is  necessary  in  this  place  to  make  mention  of  one  work 
by  living  authors,  as  its  appearance  marked  a  new  departure  in 
medico-legal  literature,  and  as  in  it  the  fact  that  forensic  med- 

i"Handb.  d.  ger.  Med.,"  Berlin,  Statistik,"  etc.,   Berl.,   1846;    "Ge- 

1841.  richtl.  Leichen-Oeffnungen, "  Berl., 

-  "Enzyklop.  Haudb.  d.  ger.  Arz-  1851-53,  1850-52;  "KlinischeNovel- 

neyk.,"  Leipzig,   1838-40,    2  vols.  ;  len,"etc.,  Berl.,  1863. 

Magazin  f .  die  Staatsarzneykunde.  "^''Tract.    Handb.   d.  ger.  Med.," 

3  Ceutralarch.    f.    d.    ges".    Staats-  Berl.,  Ite  Aufl. ,  1857-58  ;  8te  Aiifl., 

arznk. ,    Ansbach,   1844-49;  Blatter  Berl.,  1889,  also  translation  of  (reo. 

f.    d.    gerichtliche    Anthropologie.  Balfour,  New  Sydenham  Soc. .  Lon- 

Erlangen,    1850,  now  published  at  don,  1861-65.     The  fourth  and  suc- 

Erlangeu    under    the    title    Fried-  ceeding   editions,    published    after 

reich's  Blatter  f.  ger.  Med.  u.  Sani-  Casper's  death  (1864).  were  edited  by 

tatspolizei.  Karl  Liman,   his   successor  in  the 

^  "Gutachten  u.  AufsJitze, "  etc.,  chair  of  medical  jurisprudence  (d. 

Leipzig,  1847;  "Auswahl  von  Gut-  1892). 

achten,"  etc.,  Dresden.  1853.  '  Vierteljahresschr.   f.  ger.  u.  of- 

'"Beitrage    z.    medicin.    Statis-  fentl.  Med. .  Berl. .  1852,  edited  after 

tik,"  etc.,   Berl..    1825-35,  2  vols.;  Casper's  death   by   Horn.    1865-70, 

" Denkwiirdigkeiten     z.     medicin.  Eulenberg,  1871-90,  Wernicli,  1891. 


XXll  INTRODUCTION. 

icine  extends  over  so  wide  a  field  of  inquiiy  as  to  require 
treatment  at  the  hands  of  specialists  was  first  recognized.  To 
Josef  von  Maschka,  professor  in  the  University  of  Prague,  the 
credit -is  due  of  having  been  the  first  to  produce,  with  the  col- 
laboration of  twenty-two  colleagues,  a  trul}'  systematic  work  on 
modern  forensic  medicine.' 

English  works  upon  this  subject  did  not  exist  prior  to  the 
present  century, '^  although  physicians  were  emplo3'ed  b}"  the 
courts  to  determine  medical  questions  of  fact  at  a  much  earlier 
date.  Paris  and  Fonblanque,  in  the  third  Appendix  of  their 
"  Medical  Jurisprudence, "  give  the  text  of  reports  by  the  Colleges 
of  Physicians  of  London  and  of  Edinburgh  concerning  the  cause 
of  death  as  early  as  1632  and  1687  respectively.' 

Lectures  on  medical  jurisprudence  were  given  at  the  Uni- 
versity of  Edinburgh  by  A.  Duncan,  Sr.,  at  least  as  early  as 
1792.*  The  title  of  Professor  of  Medical  Jurisprudence  in  a 
British  university  was  conferred  for  the  first  time,  however, 
upon  A.  Duncan,  Jr.,  at  the  University  of  Edinburgh  in 
1806.' 

The  first  English  work  on  medical  jurisprudence  worthy  of 
consideration  is  the  medical  classic  known  as  Percival's  "  Med- 
ical Ethics."     This  was  first  published  in  1803,  and  contains  in 

1  "Handb.  d.  ger.  Med.,"  Ti'ibin-  his  " Elements  of  Medical  Jurispru- 

gen.  1881-83,  4  vols.  dence, "  to  which  Percival   ("Med. 

■-■  Daniel:  "Bibl.  d.  Staatsarznk. , "  Ethics,"  Oxford,  1849,  p.  102)  justly 

Halle.     1784,     No.    107,    mentions:  refers  as  " a  valuable  epitome  of  S. 

"E.    Prat,    Rationarium    chirurgi-  F.   Faselii's   "Elementa    Medicina? 

cum,  oder  nothwendiges  Handbuch  Forensis    [Regiom.,   4to,    1787],    in 

des  Wundarztes,  wie  er  Bericht  an  English  by  Dr.  Farr. " 

die  Obrigkeit  thun  soil u.  s.  w.,  aus  ^  "'Med.   Jur. ,"     iii.,   p.    226  seq. 

dem  Engl.,"  Harab.,  1684.  4,  690.  8.  Report  that  Joseph  Lane  died  of  poi- 

The    same    title  is  reproduced   by  son  (1628).     Report  that  Sir  James 

Wildberg  (No.  239)  in  1819,  and  the  Standsfield  was  strangled  and  not 

edition    of    1684  is    mentioned   by  drowned,  with  account  of  autopsy 

Ploucquet,   "Initia"    (1803),  Suppf.  (1687).       Also    extracts    from    the 

iv.,    36,    and    "Lift.     med.    dig."  medical  evidence   in   the   cases  of 

(1809),  iii.,  54,  the  name  of  the  au-  Spencer  Cowper   (from  13  Howell's 

thor  being  given  as  "Pratt  (Elias)."  "State  Trials")  :  Mary  Blandy  (Ox- 

This  may  be  an  early  work  by  Ellis  ford,   1752)  ;  John  Donellan   (War- 

Pratt,  but  we  can  find  no  mention  wick,    1781)  ;    and    R.    S.    Donnall 

of  it  elsewhere.     In  the  years  1734,  (Launceston,  1817). 

1761.  and  1787 dissertations  onabor-  •*  "Heads  of  Lectures  on  Medical 

tion   were  defended  at  Edinburgh  Jurisprudence,  or  the  Institutiones 

by    Arnot,    Harris,     and    Murray.  Medicinge  legalis,"  vi.,  24  pp.,  8vo, 

Three  treatises  on  death  from  suffo-  Edinb. ,  1792. 

cation    by   Goodwyn.     Frank,    and  ^  ggg.  g^p]^  .  "Med.  Jur. ,"  7th  ed., 

Coleman  "appeared   in  1788-91.     In  xvi. ,  and  note. 
1788  S.    Farr  published  at  London 


INTRODUCTION.  XXlll 

its  fourth  chapter  an  admirable  epitome  of  legal  medicine. '  A 
more  elaborate  work,  based  very  largely,  however,  upon  the 
writings  of  continental  authors,  was  published  by  G.  E.  Male 
in  1816.''  In  1821  Professor  John  Gordon  Smith  published  the 
first  systematic  treatise  on  forensic  medicine,^  and  was  one  of 
the  first  in  Great  Britain  to  show  the  importance  of  the  subject. 
Two  years  later,  in  1823,  appeared  the  elaborate  and 
scholarly  work  of  Dr.  Paris  and  Mr.  Fonblanque,  the  first  in 
the  English  language  in  whose  authorship  members  of  the 
medical  and  legal  professions  were  associated.*  In  1831,  Prof. 
Michael  Ryan  published  the  first  edition  of  his  "  Manual  of 
Medical  Jurisprudence"  from  the  memoranda  of  his  lectures  on 
the  subject  in  the  Westminster  School  of  Medicine.^  A  similar 
work  was  published  by  Professor  T.  S.  Traill,  of  the  Univer- 
sity of  Edinburgh,  in  1836."  The  awakened  interest  in  medico- 
legal subjects  among  the  medical  profession  during  the  decade 
1830-40  is  evidenced  bj^  the  publication  in  the  medical  jour- 
nals of  the  lectures  of  A.  Amos,  in  1830-31;  of  A.  T.  Thomson, 
at  the  London  University,  in  1834-35;  of  H.  Graham,  at  West- 
minster Hospital,  in  1835;  of  W.  Cummin,  at  the  Aldersgate 
Street  School,  in  1836-37;  and  of  T.  Southwood  Smith,  at  the 
Webb  Street  Theatre  of  Anatomy,  in  1837-38.' 

'  In  the  preface  Dr.  Percival  says  :  Edinb.  M.  andS.  Jour.,  and  "Hints 

"'This  work  was  originally  entitled  for    the    Examination    of    Medical 

'Medical  Jurisprudence, '  but  some  AVitnesses. "    Lond.,    1839,   died    at 

friends  having  objected  to  the  term  the  age  of  forty-one  in  1833,  after 

Juviapritdence  it  has  been  changed  fifteen  months'  imprisonment  in  a 

to  Ethics.''     An  unfinished  and  un-  debtors'  prison. 

pnhlished  edition,  written  prior  to  ^  "Med.  Jur. ,"  3  vols. ,  8vo,  Lon- 

1794  and  containing  Chapter  IV.,  don,  1823.     See  note  1,  p.  v. 

was  printed  about  1800  (see  Editor's  =  "A  Manual  of  Med.  Jur.,"  Lon- 

Preface,   p.    2,    and  note.   Author's  don,  1831,  2d  ed.,  1836,  Amer.  ed., 

Preface,  pp.  25.  26,  ed.  Oxford,  1849).  with  notes  by  R.  E.  Griffith,  Phila., 

-  "  An  Epitome  of  Juridical  or  Fo-  1832. 

rensic    Medicine,"  etc.,    viii.,   199  •*"  Outlines  of  a  Course  of  Lectures 

pp.,   8vo,  i^ondon,  1816,  also  in  Th.  on  Med.  Jur.," Edinb.,  1836,  2d  ed., 

Cooper's    "Tracts  on    Med.    Jur.,"  1840,  Amer.  ed.,  Phila.,  1841. 

Phila.,    1819.     In    the  preface   the  'A.  Amos,  Loud.  M.  Gaz.,  1830. 

author  refers  to  the  lectures  of  Prof .  vii.  ;   1831,   viii.     A.   T.   Thomson, 

Duncan.  Lond.   M.   and  S.   J.,  1834-35.    vi.  ; 

^  This  excellent  work  ("ThePrin-  1835,  vii.  ;  also  Lond.  Lancet.  1836- 

ciples  of  Forensic  Medicine")  went  37,  1.,  ii.     (Thomson's  lectures  were 

through  three  editions  in  six  A'ears.  printed  in  (rernian  in   book  form, 

Dr.   Smith,  who   was   a  teacher  of  Leipzig,  1840.)     H.  Graham,  Lond. 

medical  jurisprudence  in  the  Royal  M.  and  S.    J..  1835,    vi.,    vii.     W. 

Institution,   Westminster  Hospital,  Cummin,    Lond.   M.   (xaz. ,  1836  37, 

and  University  of  London,  aud  also  xix.     T.  S.  Smith,  Lond.  M.  Gaz., 

published  a  number  of  papers  in  the  1837-38,  xxi.  ;  1838,  xxii. 


xxiv  INTRODUCTION. 

Among  the  uofceworthy  contributions  to  the  science  previous 
to  1850  are  the  sA'-ritings  of  Dease  (1808),  Haslam  (1817,)'  Cliris- 
ti&on,  the  successor  of  Professor  Duncan  in  the  University  of 
Edinburgh,  and  best  known  as  a  toxicologist,  Forsyth  (1829),* 
Chitty  (1834),=  Watson  (1837),^  Brady  (1839),^  Skae  (1840)," 
Pagan  (1840),'  and  Sampson  (1841).' 

In  1836,  Dr.  Alfred  Swaine  Taylor  (b.  1806,  d.  1880),  the 
first  Professor  of  Medical  Jurisprudence  in  Guy's  Hospital,  pub- 
lished his  "Elements  of  Medical  Jurisprudence."  This,  the 
most  important  work  upon  the  subject  in  the  English  language, 
is  now  in  its  twelfth  English  and  eleventh  American  edition. 
During  forty  years  of  devotion  to  forensic  medicine  Dr.  Taylor 
also  contributed  other  important  works  and  numerous  papers, 
published  for  the  most  part  in  the  Reports  of  Guy's  Hospital.' 
In  1844,  Dr.  Wm.  A.  Guy,  Professor  of  Forensic  Medicine  in 
King's  College,  published  the  first  edition  of  his  excellent 
work."  In  1858,  Fr.  Ogston,  Professor  of  Medical  Jurispru- 
dence in  the  University  of  Aberdeen,  published  a  syllabus  and 
subsequently  (1878)  a  complete  report  of  his  lectures."  In  1883, 
CM.  Tidy,  Professor  of  Chemistry  and  Forensic  Medicine  in 
the  London  Hospital,  who  had  previously  (1877)  been  associ- 
ated with  W.  B.  Woodman  in  the  authorship  of  a  valuable  hand- 
book, began  the  publication  of  a  more  extended  work,  which 
was  interrupted  by  his  death  in  1892.''' 

'  Dease  :  "  Med.   Jur. , "  and  Has-  ed. ,    Lond. ,    1875.      "  Lectures    on 

lam:   "Med.   Jur.  Insanity,"  along  Med.   Jur.,"  Lond.  M.  Gaz.,    1846, 

with  the  treatises  of  Farr  and  of  n.  s.,  ii.,  iii.  ;  1847,  n.  s.,  iv.     Ar- 

Male,    are    reprinted    in    Cooper's  tides  on  arsenic,  antimony,  strych- 

"Tractson  Med.  Jur.,"Phila.,  1819.  nin,    and    other  toxicological  sub- 

'^  "Synop.  Mod.  Med.  Jur., "Lond.,  jects,    strangulation,    blood-stains, 

1829.  etc.,  in  Guy's  Hosp.  Repts. 

3  "Treatise  on  Med.  Jur.,"  Lond.,  '»" Principles  of  Forensic  Medi- 

1834;  Phila.,  1836.  cine,"   Lond.,    1844.     The  work   is 

"  "  Homicide    by    External    Vio-  now  in  its  sixth  edition,  Prof.  D. 

lence, "  Lond.,  1837.  Ferrier,    Dr.     Guy's    successor    in 

*  "Med.  Jur.,"  Dublin,  1839.  King's  College,  having  been  associ- 
^  "  Cases  in  Leg.  Med. , "  Edinb. ,  ated  in  the  authorship  of  the  4th  ed. 

1840.  in  187.5  and  subsequently. 

'  "  Med.  Jur.  of  Insanity, "  Lond.,  "  "  Lectures  on  Med.  Jur. , "  edited 

1840.  by  Fr.  Ogston,  Jr.,  Lond.,  1878. 

*  "  Criminal  Jurisprudence  in  re-  '-  Woodman  and  Tidy :  "  A  Handy- 
lation  to  Mental  Organization, "  Lon-  book  of  Forensic  Medicine  and  Tox- 
don,  1841.  icology, "  Lond.    and  Phila.,   1877. 

'•' Principles  and  Practice  of  Med.  Tidy,    "Legal    Medicine, "  3  vols., 

Jur.,"  1st  ed.,  Lond.,  1865;  8ded.,  Lond..     1882-83;    also,     Phila.,    2 

Lond.,     and    Phila.,     1883.       "On  vols.,  1882-84:  New  York,  3  vols.. 

Poisons,"  1st  ed.,   Lond.,    1848;  3d  1882-84. 


INTRODUCTION.  XXV 

The  first  Spanish  work  on  legal  medicine  was  that  of  Juan 
Fernandez  del  Valles,  printed  in  1796-97. '  No  further  contribu- 
tion to  medico-legal  literature  was  furnished  by  Spain  until  the 
appearance  in  1834  of  the  work  of  Peiro  and  Rodrigo,  which 
went  through  four  editions  in  ten  years.'  Ten  years  later,  in 
1844,  Pedro  Mata,  Professor  of  Legal  Medicine  and  Toxicolog}- 
at  Madrid,  published  the  first  edition  of  a  work,  which  in  the 
development  of  its  subsequent  editions,  has  become  the  most 
important  on  the  subject  in  the  Spanish  language.^ 

The  first  Portuguese  medico-legal  treatise  was  that  of  Jose 
Ferreira  Borjes,  first  printed  at  Paris  in  1832." 

A  posthumously  published  report  of  the  lectures  of  Albrecht 
von  Haller  was  the  earliest  Swiss  work  on  forensic  medicine.* 

In  Sweden  the  earliest  medico-legal  publication  was  a  com- 
prehensive treatise  by  Jonas  Kiernander,  in  1776,"  which  was 
followed  in  1783  by  a  translation  of  Hebenstreit,  by  R.  Mar- 
tin. The  voluminous  writings  of  the  brothers  Wistrand  (A. 
T.  and  A.  H.),  including  a  handbook,  were  published  at  Stock- 
holm, between  1836  and  1871.  Between  1846  and  1873,  several 
articles  upon  medico-legal  subjects  were  published  at  Helsing- 
fors,  in  Finland,  by  E.  J.  Bonsdorff,  O.  E.  Dahl,  and  J.  A. 
Estlander.  In  1838  Skielderup^  published  his  lectures  on  legal 
medicine,  delivered  at  Christiania,  and  Orlamundt  *  published 
a  handbook  at  Copenhagen  in  1843.  The  earliest  recognition 
of  medico-legal  science  in  Russia  was  in  the  lectures  of 
Balk,"  begun  in  1803  at  the  then  newly  founded  University  of 
Dorpat. 

Although  dissertations  upon  subjects  of  medico-legal  inter- 
est were  published  at  the  University  of  Leyden  as  early  as  the 

'  "CirurgiaForense, "etc.,  Svols. ,  •*  "Instituigoes    de  Medicina   fo- 

12ino,  Madrid,   1796-97.     Wildberg  rense, "  Paris,  1832  ;  2d  ed. ,  Lisbon, 

mentions  two  earlier  monographs  :  1840. 

"De    partu     Septimestri,"    Antvv. ,  ^  "  Vorlesungen  iiber  die  gericht- 

1568,  by  F.  Mena,  phjsician  in  or-  liche  Arzneiwisseuschaft, "  3  vols., 

dinary  to   Philip    II.  ;    and   "Diez  12mo,  Bern,  1728-84. 

privilegios  para  mugeres  prennan-  "^  "Utkasttil  Medicinal-Lagfaren- 

t€s, "  Complut.,   1606,    by  J.   A.   de  heten, "   etc.      (Project  of    medical 

Fontechia,    professor  at  Alcala  de  jnrisprudence,  etc.)     Stockh.,  1776. 

Henares.  "  "  Forelaesninger  over  den  legale 

-  "Elementos     de      Medicina     y  Medicin,"  Christiania,  1838. 

Cirurgia  legal,"  etc. ,  Madrid,  1834;  s"Haandbog   i  don  legale  Medi- 

4th  ed.,  Zaragossa,  1844.  cin, "  Kj^benhavn,  1843. 

"  "Tratadode  Medicina y  Cirurgia  ^"Versuch    eines    Umrisses    der 

legal, "  etc. ,  Madrid,   1844;  Hthed.,  philosophisch. -medizinischeu     Ju- 

4  vols. ,  8vo,  Madrid,  1874-75.  risprudenz, "  u.  s.  w.,  Dorpat,  1803 


XXVI  INTRODUCTION. 

middle  of  the  seventeenth  century,'  and  the  works  of  Pineau," 
Zacchias,"  Ludwig,'  von  Plenk/  and  Metzger*  were  printed  in 
Holland,  either  in  Latin  or  in  the  vernacular,  no  original  sys- 
tematic work  on  legal  medicine  in  the  Dutch  language  has  yet 
appeared. 

The  onlj^  Belgian  contribution  to  the  literature  of  forensic 
medicine,  other  than  articles  in  the  journals,  is  a  text-book  by 
A.  Dambre,  first  published  at  Ghent  in  1859.' 

Two  medico-legal  works  have  been  printed  in  the  Japanese 
language,  one  a  report  of  the  lectures  of  Professor  Ernst  Tiegel, 
at  the  University  of  Tokio,"  the  other  a  treatise  by  Katayama.* 

In  the  United  States  the  development  of  forensic  medicine 
has  kept  pace  with  that  in  the  mother  country.  In  an  intro- 
ductory address  delivered  at  the  University  of  Pennsylvania  in 
1810,  the  distinguished  Dr.  Benjamin  Rush  dwelt  eloquently 
upon  the  importance  of  the  subject.'"  In  1813,  Dr.  James  S. 
Stringham  was  appointed  Professor  of  Medical  Jurisprudence  in 
the  College  of  Physicians  and  Surgeons  of  New  York,  and  a  sylla- 
bus of  his  lectures  was  published  in  the  following  year. "  At 
the  same  period  (1812-13)  Dr.  Charles  Caldwell  delivered  a 
course  of  lectures  on  medical  jurisprudence  in  the  University 
of  Pennsylvania.'^  In  1815,  Dr.  T.  R.  Beck  was  appointed  Lec- 
turer on  Medical  Jurisprudence  in  the  College  of  Physicians  and 
Surgeons  of  the  Western  District  of  the  State  of  New  York; 
and  soon  after  Dr.  Walter  Channing  was  appointed  Professor  of 
Midwifery  and  Medical  Jurisprudence  in  Harvard  University. 
In  1823,  Dr.  Williams,  in  the  Berkshire  Medical  Institute,  and 
Dr.  Hale,  of  Boston,  each  lectured  upon  the  subject.'^ 

In  1819,  Dr.  Thomas  Cooper,  formerly  a  judge  in  Pennsyl- 

'  See     "Wildberg:      "Bibl.     med.  '  "Saiban  igaku  teiko"    (Medical 

leg.,"Nos.  1,198.  1.143,  1,215.  Juris.),  3  vols.,  Tokio,  1882-84. 

'^  Lugd.  Bat.,  1610,  etc.  '•'"Sixteen      Introductorv      Lec- 

3  Amstel.  1615.  tures."  etc.,   Phila.,   1811,  pp.  363- 

4Rotterd.,  1767.  395. 

^  Lugd.  Bat.,  1768.  "  Amer.  Med.  and  Phil.  Reg.,  N. 

6  S.  Gravenh. ,  1815.        ^  Y. .  1814,  iv. ,   614.     It  is  to  be  re- 

'  "Traite  de  Medecine  legale  etde  gretted  that  instruction  in  medical 

Jurisprudence  de  la  Medecine, "  2  jurisprudence  is  not  now  given  at 

vols,   in  1,   Gand.,  1859-60;  2d  ed.,  this  school  (1893). 

Paris,  1878  :  3d ed. ,  Bruxelles,  1885.  ''^  Beck  :    "Med.    Jur. , "   7th   ed. , 

(See  Toxicology.)  xix.     The  Index  Catalogue  contains 

''"Yei  sei  honron  "  (Lectures  on  the   titles   of   forty-nine   works   by 

medical    jurisprudence,     translated  Caldwell,  none  of  which  are  medico- 

by   Gento    Ove),    3d   ed.,    2   vols.,  legal. 

Tokio,  1880.  "  's  geek,  loc.  cit. 


INTRODUCTION.  XXvii 

vaiiia,  and  at  that  time  Professor  of  Chemistry  and  Mineralogy 
in  the  University  of  Pennsylvania,  reprinted,,  with  nores  and 
additions,  the  English  works  of  Farr,  Deaso,  Male,  and  Haslam." 
The  works  of  Ryan,  Chitty,  Traill,  and  Guy  were  also  reprinted 
in  this  country  shortly  after  their  publication  in  Kngland. 

In  18"2:),  Dr.  Theodric  Romeyn  Beck  published  at  Albany 
the  first  edition  of  a  treatise  as  admirable  for  scholarly  elegance 
of  diction  as  for  profound  scientific  research.  This  remarkable 
work,  facile  princeps  among  English  works  on  legal  medicine, 
has  had  twelve  American  and  English  editions,  and  has  been 
translated  into  German  and  Swedish.^ 

Papers  upon  medico-legal  subjects  or  reports  of  lectiu-es 
were  published  by  J.  W.  Francis,'  J.  Webster,'  R.  E.  Griffith,' 
R.  Dungiison,' J.  Bell,' and  S.  W.  Williams'  between  18-^:]  and 
1835.  In  1840,  Amos  Dean,  Professor  of  Medical  Jurispru- 
dence at  the  Albany  Medical  College,  published  a  medico-legal 
work,  followed  by  another  in  1854,  which  with  the  later  work 
of  Elwell  are  the  only  treatises  on  forensic  medicine  upon  the 
title-pages  of  which  no  physician's  name  appears." 

iSTumerous  papers  and  tracts  upon  medico-legal  subjects  were 
published  by  J.  J.  Allen,  T.  D.  Mitchell,  H.  Howard,  D.  H. 
Storer,  J,  S.  Sprague,  J.  S.  Mulford,  J.  F.  Townsend,  and  A. 
K.  Taylor  between  1840  and  1855.  In  the  latter  year  appeared 
the  first  edition  of  the  admirable  work  of  F'rancis  Wharton  and 
Dr.  More  ton  Stille,  the  first  American  product  of  the  collabora- 
tion of  members  of  the  two  professions,  now  in  its  fourth  edition. '" 

Between   1855  and  18(30  no  systematic   treatises   on   legal 

'''Tracts    on    Medical    Jurispru-  Phila.,     1829,    and    "Syllabus  of  a 

denc3,  "etc.,  Phila.,  1819.  Course  of  Lectures  on  .    .    .   Medical 

'^  "  Elements  of  Medical  Jurispru-  Jurisprudence  in  the  Philadelphia 

deuce,"  3  vols.,  8vo,  Albany,   1823;  Medical  Institute"  [n.  p.,  n.  d.J. 

12th  ed.,  2  vols.,  8vo,  Phila.,  1863.  >*  -'A  Catechism  of  Medical  Juris- 

A  chapter  on  Infanticide  by  John  prudence, "  etc., Northam])tou.  1835. 

B.  Beck  was  added  to  the  third  edi-  "  Dean  (A.)  :  "Mainial  of  IMedical 

tion.     This  and   later   editions   are  Jmisprudeuce,"  Albany,  1840  ;  Dean 

"byT.  R.  and  J.  B.  Beck."  (A.)  :  "Principles    of  '  IMedical  Ju- 

'  N.    Y.   Med.   and   Phys.     Jour..  risi)rudence,"  Albany,  18.~)4  :  Elwell 

1823,  ii.,   9-30.  (J.   J.)  ,  "Medicolegal  Treatise  on 

-  "An  Essay  on  Medical -Airispru-  Malpractice    and    Evidence."   Np\v 

dence, "  Phila. ,  1824.  York,      1S60;   4th   ed..    New   York 

'-  Pliila.  J.  M-  and  Pliys.  Sc. ,  1825,  1881 . 

X. ,  3(5— 1().  "'  "  M  H  d  i  c  a  1        Jurisprudence. " 

""Syllabus    of    Lectures,"     etc.,  Phila..   1855.  4th  ed  .  ►^dited  by  R 

Univ,  of  Va. ,  1827.  .Atnnry    and    K     .S     Wood,   3  vols.. 

'  "  An  Introductory  Address, "  etc. ,  Pliila . ,   1884. 


XXVin  INTRODUCTION. 

medicine  were  published,  although  the  medical  journals  con- 
tained numerous  articles  bearing  upon  the  subject.  In  1860 
the  first  edition  of  a  treatise  written  from  the  legal  aspect  was 
published  by  J.  J.  El  well.'  In  1801)  Dr.  J.  Ordronaux,  recently 
deceased,  widely  known  as  a  teacher  of  legal  medicine  and  a 
graduate  in  law  r,s  well  as  in  medicine,  published  a  treatise 
which  has  been  extensively  used  as  a  text-book.^  At  the  pres- 
ent time  the  great  number  and  variety  of  articles  published  in 
the  medical  and  legal  journals,  bearing  upon  every  branch  of 
forensic  medicine  and  of  medical  jurisprudence,  and  written  for 
the  most  part  by  specialists,  is  evidence  of  the  assiduity  with 
which  the  science  is  cultivated. 

The  wide  appreciation  of  the  importance  of  medico-legal 
science  in  the  United  States  is  also  indicated  b}"  the  fact  that 
at  the  present  time  there  are  but  few  medical  schools  in  which 
the  subject  is  not  taught.  To  ascertain  the  extent  of  medico- 
legal instruction  at  the  present  time,  a  circular  of  inquiry  was 
sent  to  the  deans  of  124  medical  schools  and  of  56  law  schools  in 
the  United  States  and  British  provinces.  Answ^ers  w^ere  received 
from  103  medical  colleges.  Of  these  only  3  are  without  a  teacher 
of  "medical  jurisprudence."  In  38  the  teacher  is  a  phj'sician, 
in  50  he  is  a  lawyer,  in  5  he  is  a  graduate  in  both  professions, 
and  3  have  two  teachers,  one  a  lawyer,  the  other  a  physician 
The  average  number  of  lectures  given  is  21,  and  the  average  in 
those  schools  in  which  the  teacher  is  a  lawj^er,  and  therefore 
presumably  teaches  only  medical  jurisprudence,  is  15.  The 
medico-legal  relations  of  their  subjects  are  taught  in  their  lec- 
tures by  the  neurologist  in  62  schools,  by  the  surgeon  in  66,  by 
the  obstetrician  in  69,  and  by  the  chemist  (toxicology)  in  91. 
It  appears  from  these  reports  that  not  only  is  the  importance  of 
medico-legal  science  appreciated,  but  that  in  the  majority  of 
our  medical  schools  the  distinction  betw^een  medical  jurispru- 
dence and  forensic  medicine  is  recognized  in  the  fact  that  the 
instructor  is  a  lawyer,  who  presumably  teaches  medical  juris- 
prudence, wdiile  the  different  branches  of  forensic  medicine  and 
toxicology  are  taught  by  the  specialists  most  competent  to 
deal  with  them.     Eveiy  practising  physician  requires  thorough 

'  "A    Medico-legal    Treatise    on  ^  "Tlie    Jurisprudence  of   Medi- 

Malpracticeand  Medical  Evidence,"        cine,"  etc.,   Phila.,  1869. 
N.  Y. ,  1860;  4th  ed.,   N.  Y.,  1881. 


INTRODUCTION.  xxix 

instruction  in  medical  jurisprudence,  which,  being  strictly  legal, 
is  best  taught  by  one  whose  profession  is  the  law.  The  general 
practitioner  only  requires  so  much  knowledge  of  the  different 
branches  of  forensic  medicine  as  will  enable  him  to  intelligently 
fulfil  his  obligations  in  such  medico-legal  cases  as  will  be  forced 
upon  him  as  results  of  his  ordinary  practice.  He  can  become 
a  medical  exjDert  only  by  a  particular  study  of  and  a  large  ex- 
perience in  some  particular  branch  of  the  subject. 

In  our  law  schools  the  teaching  of  medico-legal  science  is 
not  as  general  as  in  schools  of  medicine.  Of  35  law  schools, 
only  10  have  professors  of  medical  jurisprudence.  Of  these  0 
are  law3^ers,  1  is  a  physician,  2  are  graduates  in  both  profes- 
sions, and  1  is  a  doctor  of  divinity. 

In  this  work  the  existence  of  specialists  in  the  various 
branches  of  medico-legal  science  has  been  recognized  for  the 
first  time  in  a  treatise  in  the  English  language.  Each  branch 
has  been  assigned  to  a  specialist  in  that  subject,  or  at  least  to 
one  who  has  made  it  a  particular  study. 

In  the  arrangement  of  the  matter,  the  primary  division  into 
the  three  sciences  of  medical  jurisprudence,  forensic  medicine, 
and  toxicology  has  been  adopted.  The  division  of  pure  medical 
jurisprudence  is  contained  in  the  present  volume,  while  the 
legal  aspects  of  neurologj^  obstetrics,  etc.,  will  be  treated  of  in 
future  volumes  along  with  the  subjects  to  which  thej'  relate. 
In  the  division  of  forensic  medicine  the  classification  of  Casper 
has  been  followed:  «'.e.,  Thanatologicalj  including  those 
branches  in  which  the  subject  of  inquiry  is  a  dead  body  (con- 
tained in  the  present  volume).  Bio-thanatological;  relating 
to  questions  concerning  both  dead  bodies  and  living  persons  (in 
the  second  volume).  Biological;  relating  to  living  persons  (in 
the  second  and  third  volumes).  The  applications  of  the  micro- 
scope to  forensic  medicine  will  be  treated  of  in  the  second  vol- 
ume. The  fourth  volume  will  contain  the  division  relating  to 
toxicology. 

R.  A.    W. 


MEDICAL  JURISPRUDENCE. 


THE    LEGAL  RELATIOl^S 


PHYSICIANS  AND  SURGEONS, 

INCLUDING 

THEIR  ACQUIREMEXT  OF  THE  RIGHT  TO  PRACTISE  MEDICINE  AND 

SURGERY;  THEIR  LEGAL  DUTIES  AND  OBLIGATIONS;  THEIR  RIGHT 

TO  COMPENSATION;  THEIR  PRIYILEGES  AND  DUTIES  WHEN 

SUMMONED  AS  WITNESSES  IN  COURTS  OF  JUSTICE, 

AND  THEIR  LIABILITY  FOR  MALPRACTICE. 


BY 

TRACY  C.  BECKER,  A.B.,  LL.B., 

Counsellor-at-Law;  Professor  of  Criminal  Law  and  Medical  Jurisprudence  in  the  Law 

Department  of  the  University  of  Buffalo;  Chairman  Executive  Committee 

New  York  State  Bar  Association,  etc. 


LEGAL    STATUS    OF   PHYSICIANS. 
CHAPTER  I. 

OF  THE   RIGHT   TO   PRACTISE   MEDICINE  AND   SURGERY. 

Legal  Definition  and  History  of  the  Terms 
Physician  and  Surgeon. 

At  common  law  the  right  to  administer  drugs  or  medicines 
or  to  perform  surgical  operations  was  free  to  all.  And  such 
was  the  rule  of  the  Roman  civil  law.  But  the  importance  of 
prescribing  certain  educational  qualifications  for  those  who 
made  such  practices  their  means  of  gaining  a  livelihood  soon 
became  apparent,  and  as  early  as  the  year  1422,  during  the 
reign  of  Henry  the  Fifth  in  England,  an  act  of  Parliament  was 
adopted  forbidding  any  one,  under  a  penalty  of  both  fine  and 
imprisonment,  from  "  using  the  mysterie  of  fysyck  unless  he 
hath  studied  it  in  some  university  and  is  at  least  a  batchellor 
of  science." 

As  a  result  of  this  and  other  statutory  regulations,  a  class 
of  professional  men  grew  up,  who  were  called  "physicians," 
because  they  professed  to  have  the  qualifications  required  by 
such  legal  regulations  to  wisely  prescribe  drugs  and  medicines 
for  the  cure  of  diseases.  A  chirurgeon  or  surgeon — Latin,  chi- 
rurgus ;  Greek,  /scpoupyo's^  compounded  of  x^^Pj  the  hand,  and 
ipY^t'^,  to  work — as  the  derivation  of  the  word  shows,  was  one 
who  professed  to  cure  disease  or  injuries  by  manual  treatment 
and  appliances. 

It  would  be  more  interesting  than  profitable  to  trace  the 
history  of  these  terms,  and  of  the  professions  of  medicine  and 
surgery  from  the  early  times,  when  the  clergy  administered 
healing  to  the  body  as  well  as  to  the  soul,  and  when  barbers 
were  generally  surgeons,  and  blood-letting  by  the  knife-blade 
and  the  use  of  leeches  caused  the  common  application  of  the 
term  "leech"  to  those  who  practised  surgery. 


6  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

Definition. — For  the  purposes  of  this  treatise,  however,  it 
will  be  sufficient  to  define  the  term  "physician,"  as  meaning 
any  one  who  professes  to  have  the  qualifications  required  by 
law  to  practise  the  administration  of  drugs  and  medicines,  and 
the  term  "surgeon,"'  as  meaning  any  one  who  professes  to  have 
the  like  qualifications  to  perform  surgical  operations,  for  the 
cure  of  the  sick  or  injured. 

For  a  list  of  the  early  statutes  of  England  relating  to  the 
practice  of  medicine  the  reader  may  consult  Ordronaux'  "Ju- 
risprudence of  Medicine,"  p.  5,  note  2. 

The  present  statu torj^  regulations  throughout  the  United 
States  and  in  England  and  Canada  will  be  more  particularly 
referred  to  and  synopsized  hereafter  in  this  volume. 


CHAPTER  II. 

ACaUIREMENT  OF  LEGAL  RIGHT  TO  PRACTISE  MEDICINE 
AND   SURGERY. 

Now  Generally  Regulated  by  Statute. — In  nearly  aU  of  the 
United  States,  as  well  as  in  England,  France,  Germany,  and 
other  civilized  and  intelligent  communities,  the  legal  right  to 
practise  the  administration  of  drugs  and  medicines,  or  to  per- 
form operations  in  surgery  for  the  purpose  of  curing  diseases  or 
injuries,  has  for  many  years  been  the  object  of  statutory  legis- 
lation. The  necessity  and  propriety  of  regulating  by  law  such 
practices  is  generally  conceded.  It  is  manifest  to  all  that  a 
person  engaging  in  the  practice  of  medicine  or  surgery  as  a 
profession  is  holding  himself  out  to  the  world,  and  especially 
to  his  patients,  as  one  qualified  by  education  and  experience  to 
possess  more  than  ordinary  skill  and  ability  to  deal  with  the 
great  problems  of  health  and  life.  He  professes  to  the  world 
that  he  is  competent  and  qualified  to  enter  into  the  closest  and 
most  confidential  relations  with  the  sick  and  afflicted,  and  that 
he  is  a  fit  and  proper  person  to  be  permitted  freely,  and  at  all 
hours  and  all  seasons,  to  enter  the  homes,  the  family  circle,  and 
the  private  chamber  of  persons  suffering  from  disease  or  injury. 
All  this  he  professes  and  does  upon  his  own  account,  and  for 
his  own  profit. 

Statutory  Regulation  of  the  Right  to  Practise, 
Constitutional. — The  exercise  by  the  States  of  these  statutor}- 
powers  is  upheld  as  a  valid  exercise  of  the  "police  power,"  to 
protect  the  health  of  the  communit}'.  When  the  constitution- 
ality of  such  enactments  has  been  questioned,  it  has  been  at- 
tacked upon  the  alleged  ground  that  the  statutes  under  ques- 
tion unjustly  discriminated  in  favor  of  one  class  of  citizens  and 
against  another  class ;  and  as  depriving  those  already  engaged 
in  the  practice  of  medicine  or  surgery  of  "their  property  with- 
out due  process  of  law."     State  v.   Pennoyer,  18  Atl.   Rep., 


8  LEGAL  STATUS   OF   PHYSICIANS — BECKER. 

878;  ex  parte  Spinney,  10  Nev.,  323;  People  v.  Fulda,  52  Hun 
(N.  Y.),  Go-G7;  Brown  v.  People,  11  Colo.,  109. 

Opinion  of  United  States  Supreme  Court. — This  subject 
has  been  carefully  considered  by  the  United  States  Supreme 
Court  in  a  recent  case,  and  the  broad  extent  of  the  legislative 
powers  of  the  States  to  regulate  such  matters  clearly  and  fully 
declared.  Dent  v.  West  Va.  (129  U.  S.,  114).  The  Court  say— 
pp.  121  et  seq. — Mr.  Justice  Field  delivering  the  opinion,  in 
which  all  the  other  Justices  concur :  "  The  unconstitutionality  as- 
serted consists  in  its  [the  statutes]  alleged  conflict  with  the  clause 
of  the  Fourteenth  Amendment,  which  declares  that  no  State 
shall  deprive  any  person  of  life,  liberty,  or  property-,  without 
due  process  of  law ;  the  denial  to  the  defendant  of  the  right  to 
practise  his  profession,  without  the  certificate  required,  consti- 
tuting the  deprivation  of  his  vested  right  and  estate  in  his  pro- 
fession, which  he  had  jDreviously  acquired. 

"  It  is  undoubtedly  the  right  of  every  citizen  of  the  United 
States  to  follow  any  lawful  calling,  business,  or  profession  he 
may  choose,  subject  only  to  such  restrictions  as  are  imposed 
upon  all  persons  of  like  age,  sex,  and  condition.  This  right 
may  in  many  respects  be  considered  as  a  distinguishing  feature 
of  our  republican  institutions.  Here  all  vocations  are  open  to 
every  one  on  like  conditions.  All  may  be  pursued  as  sources 
of  livelihood,  some  requiring  years  of  study  and  great  learning 
for  their  successful  prosecution.  The  interest,  or,  as  it  is  some- 
times termed,  the  estate  acquired  in  them,  that  is,  the  right  to 
continue  their  prosecution,  is  often  of  great  value  to  the  pos- 
sessors, and  cannot  be  arbitrarilj'  taken  from  them,  any  more 
than  their  real  or  personal  property  can  be  thus  taken.  But 
there  is  no  arbitrary  deprivation  of  such  right  where  its  exer- 
cise is  not  permitted  because  of  a  failure  to  comply  with  condi- 
tions imposed  bj"  the  State  for  the  protection  of  societj'.  The 
power  of  the  State  to  provide  for  the  general  welfare  of  its 
people  authorizes  it  to  prescribe  all  such  regulations  as,  in  its 
judgment,  will  secure  or  tend  to  secure  them  against  the  conse- 
quences of  ignorance  and  incapacity  as  well  as  of  deception  and 
fraud.  As  one  means  to  this  end  it  has  been  the  practice  of 
diiferent  States,  from  time  immemorial,  to  exact  in  manj-  pur- 
suits a  certain  degree  of  skill  and  learning  upon  which  the 
communitj'  maj^  confident!}'  rely,  their  possession  being  gener- 


STATUTORY  REGULATION  OF  THE  RIGHT  TO  PRACTISE.  9 

ally  ascertained  upon  an  examination  of  the  parties  by  com- 
petent persons,  or  inferred  from  a  certificate  to  them  in  tlie 
form  of  a  diploma  or  license  from  an  institution  established  for 
instruction  on  the  subjects,  scientific  and  otherwise,  with  which 
such  pursuits  have  to  deal.  The  nature  and  extent  of  the  qual- 
ifications required  must  depend  primarily  upon  the  judgment 
of  the  State  as  to  their  necessity.  If  they  are  appropriate  to 
the  calling  or  profession,  and  attainable  by  reasonable  study  or 
application,  no  objection  to  their  validit}^  can  be  raised  because 
of  their  stringency  or  difficulty.  It  is  only  when  they  have 
no  relation  to  such  calling  or  profession,  or  are  unattainable  by 
such  reasonable  study  and  application,  that  they  can  operate  to 
deprive  one  of  his  right  to  pursue  a  lawful  vocation. 

"  Few  professions  require  more  careful  preparation  by  one 
who  seeks  to  enter  it  than  that  of  medicine.  It  has  to  deal 
with  all  those  subtle  and  mysterious  influences  upon  which 
health  and  life  depend,  and  requires  not  onlj'  a  knowledge  of 
the  properties  of  vegetable  and  mineral  substances,  but  of  the 
human  body  in  all  its  complicated  parts,  and  their  relation  to 
each  other,  as  well  as  their  influence  upon  the  mind.  The  phy- 
sician must  be  able  to  detect  readily  the  presence  of  disease,  and 
prescribe  appropriate  remedies  for  its  removal.  Every  one  inay 
have  occasion  to  consult  him,  but  comparatively'  few  can  judge 
of  the  qualifications  of  learning  and  skill  which  he  possesses. 
Reliance  must  be  placed  upon  the  assurance  given  by  his 
license,  issued  bj'  an  authorit}'  competent  to  judge  in  that 
respect,  that  he  possesses  the  requisite  qualifications.  Due  con- 
sideration, therefore,  for  the  protection  of  society,  may  well 
induce  the  State  to  exclude  from  practice  those  who  have  not 
such  a  license,  or  who  are  found  upon  examination  not  to  be 
tullj  qualified.  The  same  reasons  which  control  in  imposing 
conditions,  upon  compliance  with  which  the  physician  is  al- 
lowed to  practise  in  the  first  instance,  may  call  for  further  con- 
ditions as  new  modes  of  treating  disease  are  discovered,  or  a 
more  thorough  acquaintance  is  obtained  of  the  remedial  proper- 
ties of  vegetable  and  mineral  substances,  or  a  more  accurate 
knowledge  is  acquired  of  the  human  system  and  of  the  agencies 
b}'  which  it  is  affected.  It  would  not  be  deemed  a  matter  for 
serious  discussion  that  a  knowledge  of  the  new  acquisitions  of 
the  profession,  as  it  from  time  to  time  advances  in  its  attnin- 


10  LEGAL   STATUS   OF  PHYSICIANS — BECKER. 

ments  for  the  relief  of  the  sick  and  suffering,  should  be  required 
for  continuance  in  its  practice,  but  for  the  earnestness  with 
which  the  plaintiff  in  error  insists  that,  by  being  compelled  to 
obtain  the  certificate  required,  and  prevented  from  continuing 
in  his  practice  without  it,  he  is  deprived  of  his  right  and  estate 
in  his  profession  without  dvie  process  of  law.  We  perceive 
nothing  in  the  statute  which  indicates  an  intention  of  the  legis- 
lature to  deprive  one  of  any  of  his  rights.  No  one  has  a  right 
to  practise  medicine  without  having  the  necessary  qualifications 
of  learning  and  skill ;  and  the  statute  only  requires  that  who- 
ever assumes,  by  offering  to  the  community  his  services  as  a 
physician,  that  he  possesses  such  learning  and  skill,  shall  pre- 
sent evidence  of  it  by  a  certificate  or  license  from  a  body  desig- 
nated by  the  State  as  competent  to  judge  of  his  qualifications. 
As  we  have  said  on  more  than  one  occasion,  it  may  be  difficult, 
if  not  impossible,  to  give  to  the  terms  'due  process  of  law  '  a 
definition  which  will  embrace  every  permissible  exertion  of 
power  affecting  private  rights  and  exclude  such  as  are  forbid- 
den. They  come  to  us  from  the  law  of  England,  from  which 
country  our  jurisprudence  is  to  a  great  extent  derived,  and 
their  requirement  was  there  designed  to  secure  the  subject 
against  the  arbitrary  action  of  the  crown  and  place  him  under 
the  protection  of  the  law.  They  were  deemed  to  be  equivalent 
to  'the  law  of  the  land.'  In  this  country  the  requirement  is 
intended  to  have  a  similar  effect  against  legislative  power, 
that  is,  to  secure  the  citizen  against  any  arbitrary  deprivation 
of  his  rights,  whether  relating  to  his  life,  his  liberty,  or  his 
property.  Legislation  must  necessarily  vary  with  the  different 
objects  upon  which  it  is  designed  to  operate.  It  is  sufficient, 
for  the  purposes  of  this  case,  to  saj^  that  legi;;lation  is  not  open 
to  the  charge  of  depriving  one  of  his  rights  without  due  proc- 
ess of  law,  if  it  be  general  in  its  operation  upon  the  subjects 
to  which  it  relates,  and  is  enforceable  in  the  usual  modes  estab- 
lished in  the  administration  of  government  with  respect  to 
kindred  matters :  that  is,  by  process  or  proceedings  adapted  to 
the  nature  of  the  case. " 


early  common-law  rule.  h 

Early  Common-Law  Rule  Concerning  Suits  by 
Physicians. 

The  common-law  rule  was  that  the  physician  could  not  sue 
and  recover  for  his  services,  though  he  might  for  the  medi- 
cines he  furnished.  The  theory  of  the  law  followed  the  eti- 
quette of  his  profession  and  forbade  him  from  making  a  spe 
cific  contract  for  pay  for  his  services,  and  obliged  him  to 
receive  what  his  patient  chose  to  give  him,  which  was  called 
his  "honorarium.^'' 

The  Early  Commoii-Laiv  Rule  No  Longer  in  Force. — 
As  time  went  on  this  theory  vanished  from  the  law.  For 
many  years  it  has  lost  its  place  among  the  rules  of  professional 
etiquette.  In  its  stead  statutory  provisions  have  been  adopted 
which  forbid  a  recovery  for  services  performed  by  persons 
not  legally  authorized  to  practise.  The  right  to  contract  with 
the  patient  or  with  those  who  employ  the  medical  man,  and  his 
remedies  to  enforce  such  contracts,  will  be  treated  of  hereafter. 

Statutory  Regulations  in  New  York  State. — Most  of  the 
States  of  the  United  States  have  enacted  statutory  regulations 
prescribing  in  one  form  or  another  the  necessary  qualifications 
which  entitle  a  physician  or  surgeon  to  practise,  and  prescrib- 
ing penalties  for  practising  without  having  complied  with  such 
statutory  requirements.  In  the  State  of  New  York  such  mat- 
ters were  regulated  for  the  first  time  by  statute  in  1787.  This 
was  followed  by  a  general  enactment  on  the  subject  of  the 
organization  of  county  medical  societies,  and  of  State  medical 
societies  having  boards  of  censors,  to  whom  was  committed 
the  power  to  examine  applicants  for  license  to  practise,  and  of 
issuing  licenses  (Laws  of  1813,  p.  91).  This  law  remained  in 
force,  with  certain  modifications,  until  1814,  when  all  acts  reg- 
ulating the  practice  of  medicine  and  surgery  were  repealed. 
A  history  of  the  statutory  regulations  in  New  York  State  up  to 
the  act  of  1811  on  this  subject  will  be  found  in  the  case  of 
Bailey  v.  Mogg,  4  Denio,  GO.' 

At  the  time  of  the  passage  of  the  act  of  1813,  and  for  many 

'  In  that  case  (Bailey  v.    Mogg) ,  nostrums  of  every  description  and 

the  Court  says  of  that  statute  (Laws  admixture  could  now  be  safely  pre- 

of  1844,  p.  406)  :  "The  triumph  was  scribed,  and  payments  therefor  ex- 

uow    complete,   for  the    legislature  acted  by  authority  of  law. " 
had  made  every  man  a  doctor,  and 


12  LEGAL   STATUS   OF   PHYSICIANS— BECKER. 

years  afterward,  nearly  all  of  the  physicians  in  New  York  State 
practised  in  accordance  with  the  theories  and  precepts  of  what 
is  now  called  the  regular  or  allopathic  school  of  medicine. 
That  act  provided  that  the  physicians  in  the  respective  counties 
of  the  State  of  New  York  should  meet  in  the  respective  coun- 
ties and  organize  county  medical  societies.  As  a  consequence 
of  the  fact  that  the  physicians  of  that  day  were  chiefly  of  the 
allopathic  school,  they  necessarily  obtained  the  control  of  the 
county  medical  societies  and  State  medical  societies.  Hence 
it  became  difficult,  if  not  impossible,  for  physicians  who  wished 
to  practise  upon  other  theories  and  tenets  than  those  obtaining 
in  that  school,  to  obtain  licenses  to  do  so.  With  the  growth 
■of  the  homoeopathic  school  of  medicine  and  the  eclectic  school 
of  medicine,  came  applications  to  the  legislature  asking  for 
those  practising  under  those  schools  the  same  rights  and  priv- 
ileges of  organizing  county  and  State  societies  as  had  been  ex- 
tended to  physicians  generally  by  the  act  of  1813;  so  that  in 
1857,  by  Chapter  384,  the  legislature  of  New  York  State  enacted 
that  the  homoeopathic  physicians  might  meet  in  their  respective 
counties  and  organize  county  medical  societies,  with  boards  of 
censors  having  the  same  powers  and  privileges  which  were 
granted  by  the  act  of  1813;  and  by  other  laws  similar  privileges 
were  granted  to  the  so-called  eclectic  school.  After  the  pas- 
sage of  the  act  of  1844,  down  to  about  1874,  as  hereinbefore 
stated,  there  was  no  limitation  upon  the  right  to  practise  medi- 
cine or  surgery  in  this  State. 

The  inharmonious  and  injurious  effect  of  such  policy  of  the 
State  becoming  manifest,  the  legislature,  by  Chapter  436  of  Laws 
of  1874,  required  all  persons  desiring  to  practise  medicine  or 
surgery  to  obtain  a  certificate  as  to  their  qualifications  from 
the  censors  of  some  one  of  these  medical  societies.  By  the  Laws 
of  1880,  Chapter  513,  additional  and  more  extensive  and  partic- 
ular provisions  were  made  in  reference  to  this  matter,  and  all 
the  physicians  then  practising  were  required,  on  or  before  the 
time  limited  in  the  act,  to  file  with  the  county  clerks  of  their 
respective  counties  their  licenses  to  practise  granted  by  the 
censors  of  their  county  medical  societies,  or  a  diploma  of  some 
chartered  school  of  medicine ;  and  those  persons  who  desired  to 
become  licensed  who  were  not  in  practice  were  likewise  re- 
quired to  obtain  similar  licenses  or  certificates  and  file  the  same. 


RECENT   LEGISLATION   IN   NEW    YORK   STATE.  13, 

A  diploma  of  a  chartered  school  or  medical  college  was  given 
the  same  effect  as  a  license  issued  by  the  censors. 

Recent  Legislation  in  New  York  State. — The  whole  mat- 
ter, however,  of  licensing  physicians  to  practise  has,  in  the 
State  of  New  York,  been  recentl}'-  regulated  by  Chapter  468, 
Laws  of  1889,  and  499  of  1890,  which  have  reference  to  the 
qualifications  of  persons  becoming  medical  students,  and  Chap- 
ter 507  of  1890,  which  gives  to  the  Regents  of  the  University 
of  the  State  of  New  York  power  to  select  boards  of  examiners 
from  persons  nominated  by  each  of  the  three  State  medical 
societies,  viz.,  the  New  York  State  Medical  Society,  Homoe- 
opathic Medical  Society,  and  Eclectic  Medical  Society.  These 
boards  prepare  questions  which  are  to  be  approved  by  the  State 
Board  of  Regents ;  examinations  are  held  in  different  parts  of 
the  State  upon  these  questions,  the  examination  papers  are 
certified  to  that  one  of  these  boards  of  examiners  which  the 
student  may  elect,  and  that  board  in  turn  certifies  whether  or 
not  the  examination  has  been  successfully  undergone ;  and  upon 
its  certificate  the  Board  of  Regents  licenses  the  student  to  prac- 
tise, and  his  examination  papers  are  filed  in  the  office  of  the 
Board  of  Regents  and  become  a  matter  of  record.  These  pro- 
visions have  been  enlarged  and  modified  slightl}'  by  various  stat- 
utes since  enacted.  They  are  all  now  embodied  in  Chapter  601 
of  Laws  of  1893.    They  will  be  found  carefulty  synopsized  below. 

Penal  Provisions  in  Neiv  York  State. — The  New  York 
Penal  Code,  which  went  into  effect  in  1882,  enacted  that  a 
person  practising  medicine  or  surgery,  or  pretending  to  be  a 
physician  or  surgeon,  without  a  license  or  a  diploma  from  some 
chartered  school,  should  be  deemed  guilt}'  of  a  misdemeanor 
punishable  by  fine  or  imprisonment  (Penal  Code,  Section  356); 
and  the  same  statute,  357,  made  it  a  misdemeanor  for  a  person, 
whether  licensed  or  not,  to  practise  medicine  or  surgery,  or  do 
an}'  other  act  as  a  physician  or  surgeon,  while  intoxicated,  by 
which  the  life  of  any  person  is  endangered  or  his  health  seri- 
ously affected.' 

'  Notwithstanding  these  statutory  violated  the  provisions  of  the  statute 

enactments,  it  has  been  held  that  one  against  practising  medicine  or  sur- 

■who  undertakes  to  cure  disease  by  gery  without  a  license.     Smith  i;. 

rubbing,    kneading,    pressing,  and  Lane,  24  Hun  (New  York  Supreme 

otherwise    manipulating  the  body  Court),  32. 
(massage)  is  not  liable  for  having 


14  LEGAL   STATUS   OP   PHYSICIANS — BECKER. 

Giving  "  Patented  "  Medicines  No  Exception. — At  one 
time  an  attempt  was  made  to  claim,  that  under  the  patent  laws 
of  the  United  States  a  person  had  the  right  to  administer  patent 
medicines  without  being  punishable  for  practising  without  a 
license,  but  this  doctrine  was  repudiated  by  the  courts.  Thomp- 
son V.  Staats,  15  Wend.,  395;  Jordan  ^'.  Overseers,  etc.,  4  Ohio, 
205. 

Coui'ts  may  Compel  Granting  of  License. — A  person  who 
is  qualified  and  complies  with  reasonable  rules  of  a  licensing 
body,  can  compel  such  body  to  license  him.  This  was  held  to 
be  the  law  in  the  case  of  The  People  ex  rel.  Bartlett  v.  The 
Medical  Society  of  the  County  of  Erie,  which  is  also  an  impor- 
tant authority  in  respect  to  a  vexed  question  of  medical  ethics. 
It  appeared  in  that  case  that  under  the  general  laws  of  New 
York  in  regard  to  the  organization  of  medical  societies,  a  med- 
ical society  had  refused  to  receive  as  a  member  a  person  other- 
wise qualified,  because  he  had  advertised  in  the  public  prints  a 
certain  cure,  including  a  mechanical  appliance  used  in  treating 
throat  troubles;  it  being  forbidden  by  the  code  of  ethics  of  the 
American  Medical  Association,  which  the  County  Medical 
Society  had  adopted  as  one  of  its  by-laws,  that  a  physician  or 
surgeon  should  advertise.  The  Court  of  Appeals  of  the  State 
of  New  York  held  that  this  constituted  no  defence  to  a  proceed- 
ing instituted  by  such  person  to  obtain  a  mandamus  compelling 
the  society  to  admit  him  to  membership,  if  otherwise  qualified.' 

'  Analysis  of  this  decision  shows  personal,   professional,  and    public 

that  the  main  ground,  upon  which  relations.     They  are  regulations  in 

the  court  of  last  resort  sustained  the  the  various  departments  of  morals 

right  of  the  applicant  for  admission  and  manners,  of  courtesy  and  eti- 

to  be  admitted  as  a  member  of  the  quette,  of  delicacy  and  honor.    They 

society,  was,  that  the  provisions  of  bind  those  who  pledge  themselves 

the  by-law  in    question  were    not  to  their  observance,  but  cannot  be 

specifically  made    applicable   to   a  recognized    in    law,   as    conditions 

person    applying   for  membership,  precedent  to  the  exercise  of  an  hon- 

The  Court  observed,  pp.  192  et  seq. :  orable  profession,  by  learned,  able, 

"The  regulations  embodied  in  the  and    upright  men,    who  have    not 

so-called  code  are  admirably  framed,  agreed  to  abide  by  them.     The  non- 

aud  commend  themselves  to  every  observance  of  such  regulations  may 

reader,  as  tending  to  raise  to  a  still  be  made  cause  for  exclusion  or  dis- 

higher  elevation    the   character   of  franchisement ;  but  it  must  be  either 

the  learned  and  honorable  pi-of ession  by  the  agreement  of  parties  or  bj"  the 

to  which  they  were  submitted  for  exercise  of  the  law-making  power, 

approval  and  adoption.     They  are  "  The  applicant  was  not  a  member 

not  limited    in  their  scope  to  the  either  of  the  American  Medical  As- 

range  of  moral  obligation,  but  era-  sociation    or    of    the    Erie  County 

brace  express  rules  of  conduct,    in  Medical  Society,  at  the  time  of  his 


COURTS   MAY   COMPEL   GRANTING   OF   LICENSE. 


15 


It  has  also  been  decided  that  a  medical  society  had  no  right 
to  make  a  by-law  establishing  a  fixed  fee-bill,  or  tariff  of 
charges,  and  providing  for  the  expulsion  of  a  member  charging 
at  a  different  rate  than  that  prescribed.  Such  a  by-law  was 
declared  unreasonable  and  void  in  the  case  of  People  v.  Medical 
Society  of  Erie  County,  24  Barb.,  570. 

The  effect  of  these  decisions  was,  so  far  as  they  affect  the 
validity  of  bj'-laws,  attempted  to  be  avoided  in  that  State  by 
Chapter  445  of  Laws  of  186(3,  by  which  it  is  expressly  enacted 
that  the  county  medical  societies  of  the  State  of  New  York 
may  make  such  rules  and  by-laws  as  they  see  fit,  "  not  incon- 
sistent with  the  laws  of  said  State,  and  may  enforce  them  by 
expulsion  or  other  discipline."  It  may  be  considered  doubtful 
whether  this  legislation  can  accomplish  its  purpose  in  the  case 
of  the  adoption  of  a  bj^-law  void  as  against  public  policy. 

No  Particular  Schools  Recog:nized  by  the  Courts. — 
The  general  trend  of  the  decisions  in  all  the  States,  whenever 


alleged  deviation  from  the  formu- 
las prescribed  by  these  conventional 
rules.  He  was  under  no  legal  obli- 
gation to  observe  them,  and  had 
neither  actual  nor  constructive  no- 
tice of  their  existence.  Those  who 
were  members  of  the  society  could 
not  lawfully  be  expelled  for  antece- 
dent deviation  from  the  code  (Faw- 
cett  V.  Charles,  13  Wend.,  477). 
Much  less  could  such  deviation  be 
alleged,  as  cause  for  exclusion, 
against  one  who  had  never  agreed 
to  be  bound  by  it,  and  as  to  whom  it 
was  not  merely  an  inoperative  but 
an  unknown  law. 

"  As  the  relator  demanded  admis- 
sion to  the  enjoyment  of  a  fran- 
chise to  which  he  was  presumptively 
entitled,  his  exclusion  could  be  jus- 
tified only  by  facts  repelling  the 
presumption  that  he  was  duly  qual- 
ified for  admission,  or  by  extrane- 
ous facts,  showing  that,  if  his  ap- 
plication was  granted,  there  were 
then  subsisting  causes,  making  'a 
clear  case'  for  immediate  expulsion 
{Ex  parte  Paine,  1  Hill,  665) . 

"The  burden  was  upon  the  appel- 
lant to  establish  affirmatively  the 
existence  of  svich  present  cause  for 
expulsion.  The  societj'  waived  the 
right  of  making  a  return  and  taking 


a  formal  issue  on  the  claim  of  the 
relator,  to  be  determined  as  matter 
of  fact  by  a  jurj^,  under  the  direc- 
tion of  the  court ;  but  submitted  its 
objections  in  the  form  of  affidavits, 
which  failed  to  establish  cause  either 
for  exclusion  or  expulsion. 

"The  only  specific  fact  alleged  in 
the  opposing  affidavits,  as  ground 
of  objection,  was  the  publication  by 
the  relator  of  a  professional  adver- 
tisement, which  was  inserted  in  one 
or  more  of  the  Buffalo  journals  in 
May,  1855,  and  discontinued  in  Jan- 
uary, 1857,  more  than  two  years  be- 
fore his  ajiplication  was  presented. 
It  is  charged  that  the  printing  of  this 
notice  was  an  empiricism,  and  in 
conflict  with  the  code  of  ethics 
adopted  by  the  Erie  County  Medical 
Society. 

"There  is  nothing  in  the  terms 
of  the  advertisement  from  which 
any  inference  can  justly  be  drawn 
against  the  relator,  in  respect  either 
to  his  personal  character  or  his  pro- 
fessional skill.  There  is  no  sug- 
gestion, in  the  affidavits,  that  any 
of  the  statements  of  fact  contained 
in  the  notice  are  untrue,  and  there 
is  nothing  in  its  contents  inconsist- 
ent with  perfect  good  faith  on  the 
IJart  of  the  relator.     It  refers  to  the 


IG 


LEGAL   STATUS   OF   PHYSICIANS — BECKER. 


any  questions  in  reference  to  schools  of  medicine  have  been 
before  our  courts,  is  to  avoid  recognizing  an}^  particular  system 
or  school.  The  theory  of  the  New  York  courts  upon  this  sub- 
ject is  well  expressed  by  the  liberal-minded  and  learned  Judge 
Dal}^  in  the  New  York  Court  of  Common  Pleas,  in  the  case  of 
Corsi  V.  Maretzek,  4  E.  D.  Smith,  1-5.  In  that  case  it  was 
claimed  that  a  certificate  of  incapacity  because  of  sickness, 
given  by  a  "  homoeopathic"  physician  to  an  opera-singer,  was 
not  binding.  It  was  argued  that  the  employment  of  a  "  homoe- 
opathic" physician  under  the  contract  did  not  fulfil  a  provision 
thereof  which  required  the  event  of  the  singer's  sickness  to  be 
certified  to  by  "  a  doctor,"  to  be  appointed  by  the  director. 

The  Court  said :  "  The  system  pursued  by  the  practitioner 
is  immaterial.  The  law  has  nothing  to  do  with  particular  sys- 
tems. Their  relative  merit  may  become  the  subject  of  inquirj^, 
when  the  skill  or  ability  of  a  practitioner  in  any  given  case  is 
to  be  passed  upon  as  a  matter  of  fact.  But  the  law  does  not, 
and  cannot,  supply  any  positive  rules  for  the  interpretation  of 


treatment  of  bronchitis,  asthma,  and 
consumption,  as  a  special  depart- 
ment of  tlie  profession  to  whicli  he 
had  directed  liis  particular  atten- 
tion ;  and  it  alludes  to  his  use  of 
the  method  recently  introduced,  of 
medicated  inhalation,  through  an 
instrument  appropriate  to  that  pur- 
pose, in  aid  of  such  general  ti-eat- 
ment  as  experience  had  proved  to 
be  beneficial  in  that  class  of  diseases. 
It  is  not  denied  that  the  relator  pos- 
sessed peculiar  skill  in  this  depart- 
ment of  the  profession ;  and  the 
case  discloses  the  fact  that  the 
method  of  auxiliaiy  treatment,  in- 
troduced by  him  in  the  countj^  of 
Erie,  was  not  onlj^  successful  in  his 
own  practice,  but  was  adopted, 
with  beneficial  results,  by  members 
of  the  county  society  of  high  pro- 
fessional standing,  and  that  it  was 
accepted  by  a  large  proportion  of 
the  physicians  of  Western  New 
York.  If,  at  the  time  this  remedy 
was  introduced,  he  had  been  a 
member  of  the  County  Society  or  of 
the  American  Medical  Association, 
he  would  not  have  been  at  liberty 
to  direct  attention,  through  the 
medium  of  tlie  public  journals,  to 
the  benefits  resulting  from  its  use. 


This  would,  perhaps,  have  been  un- 
fortunate for  those  who  were  suffer- 
ing, in  that  vicinity,  from  this  par- 
ticular class  of  diseases ;  but  it  is 
undoubtedly  true  that  the  suppres- 
sion of  such  an  advertisement  would 
have  been  more  considerate  toward 
his  professional  brethren,  and  more 
in  accordance  with  the  rules  of  deli- 
cacy and  good  taste.  But  an  error, 
in  this  respect,  by  one  who  had  no 
notice  of  the  society  regulation  is 
not  cause  for  disfranchisement.  The 
act  of  the  relator  was  neither  im- 
moral nor  illegal.  It  was  no  viola- 
tion of  the  by-laws  ;  for,  as  to  him, 
they  were  wholly  inoperative.  It 
was  no  present  cause  for  e.vchision: 
for  the  publication  of  the  objection- 
able notice  had  been  discontinued 
for  more  than  two  years.  Wlien  he 
applied  for  admission,  he  proposed 
to  become  bound  by  the  by-laws ; 
and  this  the  society  refused  to  per- 
mit, for  the  sole  cause  that  he  had 
not  observed  them  before  they  be- 
came rules  of  conduct  for  him. 
'  Where  there  is  no  law,  there  is  no 
transgression. '  The  relator,  there- 
fore, had  been  guilty  of  no  legal 
wrong  which  could  bar  his  claim  tO' 
the  franchise. " 


NO  PARTICULAK  SCHOOLS  RECOGNIZED  BY  THE  COURTS.         17 

medical  science.  It  is  not  one  of  those  certain  or  exact  sciences 
in  which  truths  become  established  and  fixed,  but  is  essentially- 
progressive  in  its  nature,  enlarging  with  the  growth  of  human 
experience,  and  subject  to  those  changes  and  revolutions  inci- 
dent to  any  branch  of  human  inquiry,  the  laws  of  which  are 
not  fully  ascertained.  The  labors  of  the  anatomist,  the  physiol- 
ogist, and  the  chemist  have  contributed  an  immense  storehouse 
of  facts;  but  the  manner  in  which  this  knowledge  is  to  be 
applied  in  the  treatment  and  cure  of  diseases  has  been,  and  will 
probably  continue  to  be,  open  to  diversity  of  opinion.  No  one 
system  of  practice  has  been  uniformly  followed,  but  phj^si- 
cians  from  the  days  of  Hippocrates  have  been  divided  into 
opposing  sects  and  schools.  The  sects  of  the  dogmatists  and 
the  empirics  divided  the  ancient  world  for  centuries,  until  the 
rise  of  the  methodics,  who,  in  their  turn,  gave  way  to  innu- 
merable sects.  Theories  of  practice,  believed  to  be  infallible  in 
one  age,  have  been  utterly  rejected  in  another.  For  thirteen 
centuries  Europe  yielded  to  the  authority  of  Galen.  He  was 
implicitly  followed — his  practice  strictly  pursued.  Everything 
that  seemed  to  conflict  with  his  precepts  was  rejected ;  and  yet, 
in  the  revolutions  of  medical  opinion,  the  works  of  this  un- 
doubtedly great  man  were  publicly  burned  by  Paracelsus  and 
his  disciples;  and  for  centuries  following,  tlie  medical  world 
was  divided  between  the  Galenists  and  the  chemists,  until  a 
complete  ascendency  over  both  was  obtained  by  the  sect  of  the 
"Vitalists.  This  state  of  things  has  been  occasioned  by  the  cir- 
cumstance that  medical  practitioners  have  often  been  more 
given  to  the  formation  of  theories  upon  the  nature  of  disease 
and  the  mode  of  its  treatment,  than  to  that  careful  observation 
and  patient  accumulation  of  facts,  by  which,  in  other  sciences, 
the  phenomena  of  nature  have  been  unravelled.  I  am  far  from 
undervaluing  the  great  benefits  conferred  upon  mankind  by  the 
study  of  medicine,  and  have  no  wish  to  minister  to  any  vulgar 
prejudice  against  a  useful  and  learned  profession,  but  it  is  not 
to  be  overlooked  that,  as  an  art,  it  has  been  characterized,  in  a 
greater  degree,  by  fluctuations  of  opinion  as  to  its  principles 
and  the  mode  of  its  practice,  than,  perhaps,  any  other  pursuit. 
That  it  has  been  distinguished  by  the  constant  promulgation 
and  explosion  of  theories,  that  it  has  alternated  between  the 

advancement  of  new  doctrines  and  the  revival  of  old  ones,  and 
2 


18  LEGAL   STATUS   OF  PHYSICIANS — BECKER. 

that  its  professors  in  every  age  have  been  noted  for  the  tenacity 
with  which  they  have  clung  to  opinions,  and  the  unanimity 
with  which  they  have  resisted  the  introduction  of  valuable  dis- 
coveries. They  still  continue  to  disagree  in  respect  to  the  treat- 
ment of  diseases  as  old  as  the  human  race ;  and  at  the  present 
day,  when  great  advances  have  been  made  in  all  departments 
of  knowledge,  a  radical  and  fundamental  difference  divides  the 
allopathist  from  the  followers  of  Hahnemann,  to  say  nothing  of 
those  who  believe  in  the  sovereign  instrumentality  of  water. 

"  In  fact,  nothing  comparatively  is  known  of  the  philosophy 
of  disease.  Its  eradication  or  cure,  where  the  result  of  human 
agency  is,  in  the  great  majority  of  instances,  attributable 
rather  to  the  careful  observation,  judgment  and  experience  of 
the  particular  practitioner,  than  to  the  application  of  general  or 
established  methods  available  to  all.  The  popular  axiom,  that 
'doctors  differ, '  is  as  true  now  as  it  ever  was,  and  as  long  as 
it  continues  to  be  so,  it  is  impossible  for  the  law  to  recognize 
any  class  of  practitioners,  or  the  followers  of  any  particular 
system  or  method  of  treatment,  as  exclusively  entitled  to  be 
regarded  as  doctors.  In  adverting  to  the  conflicting  views  and 
differences  of  opinion,  that  exist  and  have  ever  existed  in  the 
practice  of  the  healing  art,  it  is  not  to  call  in  question  the  value 
of  learned,  skilful  and  experienced  physicians,  but  merely  to 
show  the  error  of  attempting,  in  the  present  state  of  medical 
science,  to  recognize,  as  matter  of  law,  any  one  system  of  prac- 
tice, or  of  declaring  that  the  practitioner  who  follows  a  partic- 
ular system  is  a  doctor,  and  that  one  who  pursues  a  different 
method  is  not."  And  see  also  White  v.  Carroll,  42  N.  Y.,  161 ; 
Ordronaux'  "Jurisprudence  of  Medicine,"  27. 

This  decision  was  prior  to  the  statute  of  1874  and  the  pro- 
visions of  the  Penal  Code  before  noted.  Since  those  statutes, 
it  is  a  misdemeanor  to  practise  except  as  permitted  hj  the 
provisions  of  those  statutes. 

In    New  York  and  Elsewhere  Practitioner  Without 
License  Cannot  Sue  and  Recover  for  His  Fees. 

Since  the  passage  of  the  New  York  Act  of  1844  (Laws  of 
1844,  p.  406),  there  has  been  no  precise  statutorj^  provision  in 
that  State  prohibiting  in  terms  persons  who  practise  physic  or 


IN  NEW   YORK   AND   ELSEWHERE.  19 

surgery  without  a  license,  from  suing  to  obtain  a  recovery  for 
services  performed.  But  this  is  of  little  consequence,  for,  as  we 
have  already  stated,  so  practising  has  been  declared  to  be  a 
misdemeanor  by  the  Penal  Code  of  New  York. 

It  is  a  well-settled  principle  that  when  any  act  is  declared 
by  statute  to  be  criminal,  a  contract  calling  for  the  perform- 
ance of  such  an  act  is  illegal  and  void.  The  early  English 
authorities  on  this  point  are  fully  collated  in  Wheeler  v.  Russell 
(17  Mete,  Mass.,  258),  and  the  later  English  and  American  cases 
maj^  be  found  in  "  American  and  English  Cyclopaedia  of  Law, " 
title  "Contracts,"  Vol.  III.,  p.  872  et  seq.;  see  also  id..  Vol. 
XVIII.,  p.  440.  Further  consideration  of  the  validity  of  con- 
tracts for  medical  and  surgical  services  will  be  had  hereafter. 
A  full  sjaiopsis  of  the  statutes  of  the  different  States  regulating 
the  licensing  of  physicians  and  surgeons  in  force  at  the  time 
this  volume  goes  to  press  will  be  placed  in  another  chapter. 

In  a  suit  between  a  person  who  has  performed  medical  and 
surgical  services,  and  one  who  employed  him,  it  is  said  that 
the  person  performing  the  services  is  presumed  to  have  been 
licensed  to  do  so.'  If  the  State  sues  for  a  penalt}',  a  different 
rule  is  claimed  to  prevail.'^ 

'  In  Macpherson  v.   Cheadell    (24  also  Thompson  v.   Sayre   (1  Denio, 

Wend. ,  N.   Y. ,   15)  the  Court  said,  N.  Y. ,    75) ,    where    this    principle 

p.  24  :  seems  to  have  been  assumed  as  cor- 

"In  the  first  place  I  doubt  much  rect    without    question     upon    the 

whether  the  defendant  below,  after  strength    of     the    decision    quoted 

retaining  tlie  plaintiff  as  a  physi-  above.     A  similar  doctrine  appears 

cian  and  accepting  his  services  as  to  have  been  enunciated  in  the  State 

such,  could  call  upon    him  in  the  of  Illinois  in  Chicago  v.  Wood,  24 

first   instance    to  jorove   a   regular  111.     Apj:). ,    42;    and    Williams    i\ 

license.     In    other   like  cases,    the  People,    20  111.   App.,  92.     It  may 

presumption  is  against  the  defend-  be  sound,  and  undoubtedly  the  Eng- 

ant.     It  is  so  as  between  attorney  lish  cases  cited    in   Macpherson  v. 

and  client,  in    a  suit  for  services  Cheadell,  supra,  tend  to  support  it. 

performed  uuder  a  retainer.     Pearce  But  in  a  case  iu  which  the  physi- 

V.  Whale,  7  Donl.  &  Ryl.,  512,  515,  clan's  right  to  practise  is  denied,  the 

per  Bayley,  Judge  ;  5  Barn,  z'  Cress. ,  safe  course  will  be  for  him  to  have  a 

38,  S.  C.     There,    if    the  objection  duly  authenticated  copy  of  his  li- 

sound  in  the  fact  that  the  plaintiff  cense  ready  to  be  offered   in  evi- 

was  never  admitted,  or  that  his  ad-  dence.     The  general  rule  is  that  the 

mission  has  become  inoperative,  it  burden  is  on  the  plaintiff  toshow  all 

lies  with  the  defendant  to  sho^y  it.  tlie  facts  which  make  uj)  his  right 

Id.,  and  see  Berrvman  ii.  Wise,  44  of  recovery.     See  Bliss  v.  Brainard, 

T.  R.,  566,  and  other  cases  ;  1  Phil.  41  N.  H.,  256  ;  Salomon  r.Dreschler. 

Ev.,  227,  Cowen  v.  Hill's  ed.       Be-  4  Minn..  278;   Kane  v.  Johnston,  9 

sides,  the  conti-ary  would  be  doing  Bosw.,  N.  Y.  Superior  Ct.,  154. 
great  violence  to  the  presumption         -  That    is,    the    burden    devolves 

that   no    man    will    tran.sgress    the  upon  the  defendant,  and  tliis  not- 

command  of  a  positive  law."     See  witlistanding    the    presumption    of 


20  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

How  MAY  A  Diploma  or  License  be  Proved  in  a  Court 

OF  Law? 

It  is  evident  from  the  foregoing  considerations  that  in  any 
proceedings  to  punish  for  practising  without  license  or  legal 
authority,  and  in  actions  to  recover  payment  for  professional 
services  in  the  States  and  countries,  where  a  license  or  diploma 
of  a  regularly  chartered  school  or  college  is  required  by  statute 
to  entitle  the  person  to  practise,  it  may  become  important  to 
establish — first,  the  legal  authority  to  grant  the  license  or 
diploma ;  and  second,  the  genuineness  of  the  license  or  diploma 
produced.  It  frequently  happens  that  the  diploma  or  license 
has  been  obtained  in  another  State  or  country.  Under  the  New 
York  statutes,  especially  the  laws  of  1880  and  1890,  it  was 
made  necessary  to  file  a  diploma.  When  it  had  been  issued  by 
a  chartered  school  of  another  State  it  must  be  certified  to  by 
some  lawfully  incorporated  medical  college  in  this  State,  before 
being  received  for  filing,  or  regarded  by  the  law  as  confer- 
ring upon  its  possessor  the  right  to  practise  in  that  State. 

As  to  the  chief  element  of  authenticity,  namely,  the  legal 
incorporation  or  authority  of  the  body  or  institution  granting 
the  diploma,  it  is  clear  that  the  act  of  incorporation  itself  would 
be  the  best  evidence  of  the  incorporation  of  the  college  or  school, 
and  a  special  act  granting  the  power  to  license  to  a  board  of 
censors  or  other  official  body  or  board  would  have  to  be  pro- 
duced to  show  the  right  vested  in  that  board  or  body  to  grant  a 
license.  In  Georgia  it  has  been  held  (Hunter  v.  Blount,  27 
Ga.,  76),  that  to  prove  a  diploma  given  to  a  physician  in  an- 
other State,  the  existence  of  the  college,  and  the  fact  of  its  being 
a  chartered  institution,  must  be  shown  bj''  producing  its  act  of 
incorporation. 

In  Thornton's  case  (8  Term  Rep.,  303;  same  case,  3  Esp., 
4),  it  was  held  that  the  mere  production  in  court  of  a  diploma 
under  the  seal  of  one  of  the  universities,  is  not  of  itself 
evidence  to  show  that  the  person  named  in  the  diploma  re- 
ceived the  degree  which  the   diploma   specified.     In   another 

innocence,  of  showing  what  must  N.  Y. ,  298,  and  cases  cited  ;  1  Green- 
be  peculiarly  within  his  own  knowl-  leaf  on  Ev. ,  §79,  and  cases  cited, 
edge,  namely,  that  he  has  been  duly  See,  contra,  State  v.  Evans,  5  Jones, 
licensed.     Peoples.  Nyce,  34  Hun,  N.  C. ,  350. 


HOW   MAY   A   DIPLOMA   BE    PROVED    IN   COURT  ?  21 

and  later  case,  however,  Simpson  v.  Dunmore(9  M.  &  W,,  45; 
same  case,  5  Jurist,  1012),  it  was  held  that  it  was  unnecessary 
for  the  person  producing  a  license  from  the  Apothecaries'  Com- 
pany (an  incorporated  body)  to  practise  as  an  apothecary,  the 
seal  on  which  license  was  proved  to  be  genuine,  to  give  any 
additional  evidence  of  his  identity  with  the  person  named  in 
the  license.  The  reason  for  this  doctrine  is  probably  to  be 
found  in  the  well-known  rule  of  evidence,  that  identity  of  both 
christian  name  and  family  name,  is  sufficient  to  raise  a  pre- 
sumption of  fact  that  the  person  bearing  the  name  is  the  iden- 
tical person  so  named  in  any  written  instrument. 

In  Walmsley  v.  Abbott  (1  K.  &  P.,  309;  same  case,  5  D. 
&  R.,  62),  proof  of  the  signature  of  one  of  the  examiners  who 
signed  a  certificate  of  examination  was  held  sufficient  to  war- 
rant the  acceptance  of  the  certificate  in  evidence  in  the  first 
instance.  In  another  case  the  proof  was  that  a  person  previ- 
ously a  stranger  to  the  place  went  to  a  town  which  was  the  seat 
of  a  university,  and  was  told  that  a  certain  building  was  the 
college,  and  that  a  certain  person  whom  he  saw  there  was  the 
librarian,  and  that  this  librarian  showed  him  what  purported 
to  be  the  seal  of  the -university,  and  also  a  book  which  the 
librarian  stated  was  the  book  of  acts  or  records  of  the  univer- 
sity, and  the  seal  so  shown  him  was  compared  with  the  seal  of 
a  certain  diploma,  the  genuineness  of  which  was  in  question, 
and  a  copy  was  made  from  the  said  book  of  acts,  of  an  entry 
stating  that  the  degree  of  M.  D.  had  been  conferred  b}'  the 
university  upon  a  person  bearing  the  same  name  as  that  in  the 
diploma,  and  this  proof  was  held  a  sufficient  authentication  of 
the  diploma,  and  of  the  act  or  authority  of  the  university  con- 
ferring the  degree.  Collins  case,  1  Addison  &  Ellis,  G95;  same 
case,  3  N.  &  M.,  703.' 

The  Rule  in  Criminal  Prosecutions. — We  have  seen  above, 

'  In  Finch  15.  Gridley's  Executors  Though  he  did  not  actuallj^  see  them 

("25  Wend. ,  N.  Y. ,  469-471) ,  Nelson,  subscribe  the  paper,  he  had  every 

(h.J. ,  said:  *'I  am  also  inclined  to  means  of  becoming  acquainted  with 

think  the  evidence  which  was  given  tlieir  signatures;  the  deliver!/  of   it 

competent    to    prove    the    diploma  to    him  was    an    acknowledgment 

from   Fairfield   College.     The   wit-  they  liad  signed  it.     Besides,  he  was 

ness  identified  the  corporate  seal,  familiar  witli  diplomas  from  the  in- 

mid  had  himself  receired  a  diploma  stitutionundertheirsignature, "  etc. 

from  that  institution  subscribed  by  And  see,  also,  Rayuor  v.  State,  62 

the  same  president   and    secretary.  Wis.,  289;  Wendel-y.  State, yd. , 300. 


22  LEGAL   STATUS   OP   PHYSICIANS — BECKER. 

that  in  a  criminal  prosecution  the  burden  is  on  the  defendant 
to  produce  and  prove  his  license,  but  to  warrant  a  conviction  for 
practising  without  a  license  it  must  be  shown  that  the  accused 
actually  practised.  It  is  not  enough  to  show  that  he  is  called 
by  persons  whom  he  attends  personally,  that  is,  for  whom  he 
prescribes,  or  to  whom  he  gives  medicine  or  whom  he  treats. 
There  must  be  proof  shown  that  he  has  done  this  on  his  own 
account  or  for  his  own  profit.  But  proof  of  a  single  act  con- 
nected with  other  circumstances,  such  as  tend  to  show  that  he 
held  himself  out  as  a  physician,  is  enough.  Burham  v.  State, 
116  Ind.,  112;  Hill  v.  Bodie,  2  Stew,  and  P.  (Ala.),  50;  Ped- 
grift  V.  Schiller,  8  C.  B.,  N.  S.,  200  (same  case,  G  Jurist,  N. 
S.,  1341).  And  if  he  simply  practises  "massage,"  he  does  not 
fall  within  the  acts  against  practising  medicine,  even  though 
he  pretends  to  accomplish  as  much  good  as  could  have  been 
accomplished  by  a  regular  ph3^sician.  Smith  v.  Lane,  24  Hun, 
IST.  Y.,  632.  But  see  also  Leech  v.  Ripon,  12  Cent.  L.  J.,  479; 
State  V.  Schultz,  11  Reporter,  701.' 

Falsely  Pretending  to  he  a  Licensed  Practitioner  Gen- 
erally a  Misdemeanor. — In  some  of  the  States,  and  in  England, 
it  is  not  only  made  a  misdemeanor  to  practise  without  a  license, 
but  falsely  pretending  to  be  a  licensed  practitioner  is  made  a 
misdemeanor.  Such  is  the  provision  of  the  Penal  Code  of  New 
York  heretofore  cited.  In  England  such  a  statute  has  been 
somewhat  strictly  construed  in  the  case  of  Carpenter  v.  Hamil- 
ton (37  Law  Times  Rep.,  157).  In  that  case  it  appeared  that 
a  person  advertised  himself  as  "John  Hamilton,  M.D.,"  of  the 
"Metropolitan  Medical  College  of  New  York."  It  further  ap- 
peared that  he  was  not  registered  as  required  by  the  law  of 
England.  In  a  prosecution  against  him  for  falsely  pretending 
to  be  a  licensed  physician,  the  onh'  proof  of  his  practising  being 

'  In  some  of  the  States,  persons  and  herbs  within  the  meaning  of 

who  simply  administered  roots  and  the  statute,  or  whether,  under  tlie 

herbs  in  treating  disease,  have  been  guise  of  so  doing,  he   really  held 

excepted  from  that  portion  of  the  himself  out  as  and  acted  as'a  reg- 

statute  which  forbids  the  practice  ular    practitiouer.     All  such  penal 

of  medicine  and  surgery  without  a  statutes  are  to  be  construed,  like  all 

license.      The   proper   construction  other  penal  statutes,  with  due  regard 

of  such  an  exception  is,  that  it  is  a  to  the  rights  of  the  individual,  and 

questionof  fact  for  the  jury,  whether  at  the  same  time  with  such  degree 

the  person  accused  who  claims  the  of  liberality  as  will  tend  to  preserve 

benefit  of  the  exception,  simply  ad-  the  public  safety, 
ministered  a   concoction    of    roots 


STATE  AND  LOCAL  BOARDS  OF  HEALTH.         23 

as  just  stated,  an  acquittal  was  sustained  by  a  majority  of  the 
court,  which  held  that  it  was  a  question  of  fact  to  be  determined 
by  a  trial,  court  whether  or  not  what  he  did  was  ]jretending 
to  be  a  physician  authorized  to  treat  a  patient.  The  Court  in- 
timated that  the  person  simply  pretended  to  be  what  he  really 
was,  namely,  a  doctor  of  medicine  of  the  Metropolitan  Medical 
College  of  New  York. 

State  and  Local  Boards  of  Health— Powers 
Governed  by  Special  Statutes. 

In  addition  to  the  rules  and  regulations  prescribed  hj  the 
general  statutes,  modern  sanitary  science  has  developed  so 
broadly  throughout  most  of  the  civilized  states  and  countries, 
that  the  different  governments  have  established  state  boards  of 
health,  and  in  many  instances  local  boards  of  health,  the  latter 
being  limited  in  their  authority  and  operation  to  specific  munic- 
ipal divisions,  to  which  boards  the  government  has  committed 
the  power  to  pass  certain  sanitary  rules  and  regulations,  which 
rules  and  regulations  maj'  have  an  important  bearing  upon  and 
relation  to  the  practice  of  medicine  and  surgery.  The  jurisdic- 
tion and  powers  of  these  boards  are  to  be  found  in  the  special 
statutes  creating  them,  and  prescribing  their  powers  and  duties, 
and  cannot  be  treated  of  extensively  here.  They  will  be  con- 
sidered further  under  the  special  subjects  to  which  they  relate. 

Physicians  Bound  to  Report  Contagious  Cases  and  Not 
Liable  for  Mistaken  Report. — The  duty  to  promptly  report '  to 

^  It  has  been  held  that  the  act  of  a  which  presents  to  him  the  appear- 

physician  in  reporting  to  a  health-  ance  of  small-pox.     It  may  be  said 

board  in  good  faith  that  his  patient  that  he    may  call   in   counsel.     It 

is  suffering  from  small-pox,  is  not  cannot,  however,  be  said  that  pri- 

actionable.     Brown  v.   Purdy,  8  N.  vate    counsel    should  be  called    in 

Y.    St.  Rep.,   143.     The  Court  said  rather  than   such  as  the    law  lias 

(per  Sedgwick,  J.)  :    "In  order  to  appointed.      Certainly,  if  he  really 

give  the  public  the  protection  due  thinks  the  case  to  be  one  of  small- 

to  it,  according  to  the  intention  of  pox,  it  is  his  duty  to  communicate 

the  statute,  any  physician  that  pos-  his  opinion  to  the  public  authori- 

sesses  in  fact  an  opinion  that  a  pa-  ties,  wlio  furnish  skilled  physicians 

tient  has  a  contagious  disease,    is  peculiarly  competent  to  pass  upon 

bound  to  report  the  ease,   whether  the  case.     They  are  the  experts  the 

he  Juts  or  has  not  used  ordinary  pro-  law  points  out  for  tlie  physician, 

fessional  skill  and  knowledge.     A  The   attendance    of    these    experts 

physician  of  skill  in  everything  but  upon  a  patient  can  cause  no  injury, 

cases  of  small-pox,  which  happily  and    thereafter    the    responsibility 

are  not  numerous,   may,  unexpect-  rests  solely  upon  the  public  officer. " 

edly  to  himself,  be  called  to  a  case  As  to  how  far  the  decision  of  an 


24 


LEGAL   STATUS   OF   PHYSICIANS — BECKER. 


boards  of  health  every  case  of  contagious  or  infectious  disease 
is  manifest. 


inspector  appointed  by  a  board  of 
health  is  regarded  by  the  law  as 
quasi -judicial,  and  therefore  con- 
clusive, see  Underwood  v.  Green,  42 
N.  Y. ,  140 ;  Raymond  'O.  Fish,  51 
Conn.,  80.  Health  officers  who  were 
guilty  of  gross  negligence  in  remov- 
ing infected  jjersons  from  a  city  in 
stormy  weather,  and  putting  them 
in  an  unprotected  and  unsafe  struc- 
ture, so  that  such  persons  died  from 
the  exposure,  have  been  held  liable. 
Aaron  «.  Broiles,  64  Tex.,  316. 

The  latest  and  most  complete 
statute  laws  creating  or  regidating 
health  boards  are  :  England,  38  and 
39  Victoria,  chap.  55  ;  United  States 
(National  Board  of  Health),  20  Stat. 
L. ,  484,  suppl.  to  U.  S.  Rev.  Stats. , 
chap.  202,  passed  March  3d,  1889; 
Mass.,  chap.  79,  Mass.  Rev.  Stats.  ; 
Pa. ,  Laws  of  1885,  chap.  56 ;  New 
York  (State  Board    of    Health),    2 


N.  Y.  Rev.  Stats.,  1195;  Local 
Boards,  id.,  1191-1193.  chap.  270, 
Laws  of  1885.  The  statutes  of  New 
Jersey  are  considered  in  Lozier  v. 
Newark,  19  Vr. ,  453.  In  Missouri 
the  power  to  license  physicians  is 
conferred  upon  the  State  Board  of 
Health,  and  the  Supreme  Court  of 
that  State  has  held  that  the  act  of 
that  board  in  granting  or  refusing 
a  license  is  discretionary  and  its 
action  in  such  a  matter  will  not  be 
enforced  by  a  writ  of  viandamus 
(State  V.  Gregory,  83  Mo. ,  123) ;  and 
a  similar  doctrine  prevails  in  Min- 
nesota, State  V.  State  Med.  Board, 
32  Minn. ,  324.  The  latest  and  best 
work  on  the  general  subject  of  the 
organization  and  powers  of  boards 
of  health  is  Parker  &  "VVorthing- 
ton's  "Public  Health  and  Safety," 
M.  Bender,  publisher,  Albany,  N. 
Y.,  1892. 


CHAPTER   III. 

OF   THE   CONTRACTUAL  RELATION    BETWEEN     PHYSICIAN 

AND   PATIENT. 

Employment  and  Rights  in  Regard  to  Compensation. 

Legal  Character  of  the  Employment. — Whatever  may 
have  been  the  theories  of  the  Roman  civil  law,  and  following 
it  of  the  early  English  common  law,  as  to  the  character  of  the 
employment  of  physicians  and  other  professional  men,  it  is  now 
so  well  settled  that  the  reciprocal  duties  and  obligations  arising 
between  physician  and  patient,  or  attorney  and  client,  and  the 
like,  are  to  be  classed  under  and  governed  by  the  law  of  con- 
tracts, that  any  extended  discussion  of  these  theories  is  un- 
necessary here.'  Mr.  Ordronaux,  in  the  second  chapter  of  his 
interesting  work  on  the  "Jurisprudence  of  Medicine,"  has 
considered  them  fully,  and  has  quoted  amply  from  the  books  of 
the  earlier  and  later  text- writers,  and  from  the  expressions  of 
the  judges,  to  show  what  these  theories  and  rules  were ;  and  he 
and  all  later  authorities  agree  that  the  ancient  notion,  that  pro- 
fessional services  are  alwaj^s  gratuitous  unless  a  special  con- 
tract to  pay  for  them  is  made,  has  long  been  abandoned.  He 
observes  (pp.  13  and  14):  "But  in  our  day  the  increase  in  the 
number  of  professional  practitioners,  and  their  exclusive  devo- 
tion to  a  special  class  of  services  as  a  means  of  living,  has 
essentially  modified  the  practical  character  of  the  contracts  with 
their  patrons.  Although  in  legal  acceptation  a  mandate,  yet 
from  force  of  circumstances  growing  out  of  an  altered  state  of 
society,  the  mandate  is  practically  changed  into  a  contract  of 
hire  {locatio  operis).  This  doubtless  reduces  prof  essions  to 
the  status  of  artisanship,  and  places  them  on  a  par  with 
manual  labor,  conjoined  to  the  special  skill  of  a  particular  call- 
ing. But  it  also  simplifies  the  contract,  removes  it  from  the 
category  of  innominate  or  imperfect  obligations,  requiring  the 

'  Consult,  as  to  this,  Parsons  on  "Contracts,"  vol.  ii.,  p.  56. 

25 


26  LEGAL   STATUS   OP   PHYSICIANS — BECKER. 

intervention  of  legal  fictions  to  furnish  a  means  for  their  en- 
forcement, and  brings  it  within  the  pale  of  consensual  agree- 
ments based  upon  a  sufficient  consideration." 

The  i)liysician's  right  to  sue  on  contract  in  England  was 
declared  by  legislative  enactment  by  Chap.  90  (Sec.  31),  21  and 
22  Victoria.  It  has  never  been  denied  in  the  United  States. 
Adams  v.  Stephens,  26  Wend.,  451-455. 

Physicians'  and  Surgeons'  Service  in  a  Sense  Voluntary . 
— Though  it  is  true,  as  in  the  case  of  many  other  doctrines  of 
ancient  law  which  were  formulated  under  social  conditions  far 
different  from  those  which  prevail  in  modern  times,  that  these 
rules  and  theories  have  long  since  lost  their  potency  as  distinct 
rules  governing  actions  at  law,  nevertheless  the  legal  aspect 
of  the  peculiar  relationship  between  physician  and  patient,  is 
still  affected  by  the  idea  that  the  service  on  the  part  of  the 
physician  is  voluntary — that  is,  the  physician  or  surgeon  is  not 
bound  to  come  and  perform  services  whenever  or  wherever  he 
is  called.  He  is  at  liberty  to  refuse  any  and  every  patient  who 
attempts  to  employ  him. 

Patients  may  Cease  Employing  at  Any  Time^  unless 
there  is  a  Contract  for  a  Certain  Period. — And  when  he  is 
employed,  the  patient  may  at  any  moment  discharge  him, 
without  incurring  liability  in  damages,  unless  a  special  contract 
has  been  entered  into  between  them  that  the  services  shall  be 
rendered  for  a  fixed  period. 

Service  once  Begun  by  Physician  must  be  Continued 
until  Notice  of  Intention  to  Cease  is  Given  by  Him. — If, 
however,  the  services  are  begun,  they  must  be  continued  until 
notice  has  been  given  of  the  intention  to  discontinue  them,  and 
a  reasonable  time  allowed  the  patient  to  obtain  the  services  of 
another  person.  The  reasons  for  this  rule  will  be  considered 
more  fully  below. 

Contracts  either  Express  or  Implied. — The  contract  be- 
tween the  physician  and  patient  may  be  an  express  one,  that  is, 
one  in  which  all  the  terms  are  agreed  upon  or  expressed  be- 
tween the  parties,  or  it  may  be  what  is  called  an  implied  con- 
tract, or  one  in  which  the  patient,  or  another  person,  simply 
calls  on  the  phj^sician  or  surgeon  to  come  and  perform  services, 
and  neither  party  specifically  stipulates  or  agrees  upon  any  of 
the  terms  of  the  employment. 


CONTRACTS.  27 

Express  Contracts  may  Include  any  Stipulation  Not 
Contrary  to  Public  Policy. — lu  the  case  of  an  express  contract 
the  agreement  of  the  parties  settles  and  determines  their  mutual 
obligations,  whether  it  be  written  or  merely  verbal.  But  an 
express  contract  may  also  be  made  in  such  a  form  that  certain 
conditions  are  required  to  be  performed  by  the  physician  before 
he  becomes  entitled  to  any  compensation  for  his  services.  It 
may  also  embody  an  agreement  that  the  patient  shall  pay  cer- 
tain sums  at  certain  times  as  the  treatment  goes  on,  or  that  no 
other  physicians  shall  be  employed  without  the  consent  of  the 
attending  physician,  or  if  so  employed  that  they  shall  be  under 
the  direction  of  the  attending  physician. 

Almost  anything  may  be  stipulated  which  is  not  contrary 
to  public  policy,  and  a  breach  of  any  such  stipulation  entitles 
the  aggrieved  party  to  rescind  the  contract  and  cease  from  per- 
forming it.' 

Qualifications  of  the  Rule  that  Express  Contracts  may 
Include  any  Stipulation. — Some  qualifications  of  this  rule  of 
law  must,  however,  be  noted.  A  breach  by  the  patient  of  any 
one  of  these  stipulations  would  entitle  the  physician  to  treat  the 
engagement  as  terminated  like  any  other  contractual  relation, 
and  to  bring  his  action  for  a  recovery  for  services  rendered  up 
to  the  time  of  the  breach ;  but  it  is  doubtful  whether  he  would 
have  any  action  for  damages  for  failure  to  permit  him  to  per- 
form further  services.  This  doubt  arises  from  the  legal  doc- 
trine, hereinbefore  referred  to,  that  a  patient  is  always  at 
liberty  to  dismiss  his  physician  at  any  time  without  notice,  and 
without  assigning  any  cause,  which  recognizes  and  grows  out 
of  the  fact  that  if  the  trust  and  contidence  of  the  patient  are 
destroyed,  or  impaired,  no  matter  how  unreasonably  or  unjustly, 
the  relation  between  them  must  thereafter  be  unprofitable  to 
both  parties,  and  dangerous  to  the  patient.  On  the  other  hand 
there  is  little  doubt  but  that  whenever  an  express  contract  is 
made  by  a  physician  to  treat  a  patient  for  a  certain  length  of 
time  for  a  particular  disease  or  injur}',  the  physician  is  not  at 
liberty  to  arbitrarily  terminate  that  relation  or  his  connection 

'  Of  course  in  those  States  or  coun-  statute) ,  unless  such  contracts  are  in 

tries    in    which    statutes  of  fraud  writing  and  duly  signed,  contracts 

render  void,  contracts  for  personal  sliould  be  drawn  and  entered  into 

services  for  a  longer  period  than  one  with  regard  to  those  statutes, 
year  (or  any  period  named  in  the 


28  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

with  the  case,  unless  he  has  in  the  contract  specifically  reserved 
the  right  so  to  do. 

Contracts  Making  Payment  Contingent  upon  Successful 
Treatment  Valid. — The  express  contract  between  the  parties 
may  also  contain  a  stipulation,  by  which  the  physician  makes 
his  compensation  contingent  upon  his  effecting  a  cure.  Smith 
V.  Hyde,  19  Vt.,  54;  Mack  v.  Kelly,  3  Ala.,  387.  See  also 
CoughUn  V.  N".  Y.  Cen.  R.  R.  Co.,  71  N.  Y.,  443.  In  such  a 
case,  however,  if  the  patient  does  not  permit  the  physician  op- 
portunity to  treat  him  during  the  time  named  in  the  contract,  or 
for  a  reasonable  time,  if  no  specific  time  is  fixed,  the  courts 
would  probably  permit  the  physician  to  recover  a  reasonable 
compensation  for  his  services  for  the  time  during  which  he 
treated  his  patient. 

Physician  must  Allow  Reasonable  Time  to  Supply  his 
Place  if  he  Quits  his  Patient.- — In  any  event,  whether  the 
contract  be  express  or  implied,  conditional  or  unconditional,  the 
law  through  motives  of  public  polic}^  and  with  a  just  regard 
for  the  welfare  of  the  sick  and  injured,  undoubtedly  requires 
that  if  a  physician  has  once  taken  charge  of  a  case,  and  deter- 
mines to  abandon  it,  he  must  give  the  patient  reasonable  notice 
and  reasonable  opportunity  to  supply  his  place.  If  he  fails  to 
do  this  he  is  liable  in  damages  for  the  results  that  follow  as  the 
proximate  consequence  of  his  abandoning  the  case. 

This  Rule  Ti'ue  even  in  the  Case  of  a  Charity  Patient. — 
This  is  true,  it  is  believed,  even  when  the  patient  is  a  charity 
patient,  and  the  services  are  gratuitous.  Shiels  v.  Blackburn 
(1  H.  Blacks.,  159).  For  any  other  ruleless  strict  might  entail 
the  most  serious  consequences.  Ordronaux,  "Jur.  of  Med.," 
13  and  14,  citing  Inst.,  lib.  3,  26,  11;  Pothier,  "Du  Contrat 
Mandat,"  Chap.  I.,  §  4. 


Elements  of  the  Contract   Between   Physician  and 

Patient. 

Duties  of  Physician. — When  the  relations  between  physi- 
cian and  patient  are  not  defined  otherwise  by  express  contract, 
the  implied  contract  is,  and  the  law  presumes,  that  the  physi- 
cian contracts,  first,  to  use  the  necessary  care  and  attention ; 


CONTRACT   BETWEEN   PHYSICIAN   AND    PATIENT.  29 

second,  to  use  the  necessary  skill ;  third,  in  case  the  physician 
furnishes  his  own  medicines  (and  the  obligation  to  furnish 
them  would  probably  be  imposed,  if  it  was  the  custom  of  the 
school  or  class  of  physicians  to  which  the  particular  physician 
belonged  to  do  so),  that  the  medicines  are  proper  and  suitable. 
As  a  corollary  of  these  duties  it  necessarily  follows,  also,  that 
the  physician  contracts  that  the  instruments  or  appliances 
which  he  uses  are  free  from  taint  or  contagion,  and  are  suitable 
and  proper  for  the  uses  to  which  they  are  put.  Upon  this 
theory  an  action  could  be  maintained  against  a  physician  for 
using  impure  vaccine. 

Duties  of  Patient. — The  patient  on  his  part  contracts, 
first,  to  give  the  physician  information  concerning  the  facts  and 
circumstances  of  the  case,  and  full  opportunity  to  treat  him 
properly ;  second,  to  obey  his  instructions  and  follow  his  direc- 
tions, and,  third,  to  pay  him  the  reasonable  worth  and  value  of 
his  services.  The  different  branches  of  this  contract  are  recip- 
rocal. The  failure  of  either  party  to  fulfil  the  obligation  of  any 
one  of  them  which  is  imposed  upon  him,  would  bar  him  of  his 
remedies  against  the  other  party  to  recover  damages  for  any 
breach,  or  any  proximate  result  of  his  breach,  of  such  obliga- 
tions. The  necessary  care  and  attention  required  of  the  physi- 
cian in  such  a  case  are  measured  by  the  requirements  of  the  case 
and  the  physician's  duties  to  his  other  patients,  modified,  how- 
ever, by  the  rule  that  the  physician  is  presumed  to  know,  at  the 
time  he  takes  up  the  case,  the  condition  and  situation  of  his 
other  patients  at  that  time.  Consequently,  if  those  who  have 
first  employed  him  are  so  situated  at  the  time  that  his  services 
for  them  are  likely  to  be  soon  and  continuously  required,  he 
cannot  without  making  himself  liable  in  damages  undertake 
another  case  and  then  neglect  it,  but  he  should  either  decline  to 
take  it,  or  should  with  the  full  knowledge  and  consent  of  the 
patient  make  provision  for  the  temporary  substitution  of  some 
other  physician,  during  the  time  that  his  prior  obligations  en- 
gross his  attention.  Nevertheless,  if  the  situation  and  condi- 
tion of  those  to  whom  he  has  first  contracted  his  services  is  such 
that  he  had,  although  he  exercised  due  professional  knowledge 
and  skill,  no  reason  to  apprehend  that  these  patients  would  need 
his  exclusive  service,  and  by  a  sudden  development,  arising 
from  those  occult  causes  which  obtain  in  all  serious  diseases 


30  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

and  injuries,  any  of  his  prior  patients  suffer  a  sudden  and  dan- 
gerous relapse,  or  from  an  accession  of  new  and  dangerous 
sj'inptoms  and  conditions  so  that  he  must  fly  to  their  aid,  he 
would  not  be  liable  to  another  patient,  to  whom  he  had  after- 
ward contracted  his  services,  for  neglecting  his  case ;  still  he 
should  in  such  instances  use  extra  means  to  obtain  the  services 
of  some  other  and  equally  skilful  man. 

Only  Ordinary  and  Usual  Skill  Required. — The  degree 
and  character  of  necessary  skill  contracted  for  has  been  vari- 
ously defined  by  the  courts.  When  malpractice  is  discussed,  a 
more  extended  consideration  of  this  matter  will  be  required. 
At  present  the  doctrine  laid  down  in  Shearman  and  Redfield 
on  "Negligence,"  paragraphs  433-435,  maybe  adopted.  It  is 
as  follows : 

"Although  a  physician  or  surgeon  may  doubtless  by  ex- 
press contract  undertake  to  perform  a  cure  absolutely,  the  law 
will  not  imply  such  a  contract  from  the  mere  employment  of 
a  physician.  A  physician  is  not  an  insurer  of  a  cure,  and  is 
not  to  be  tried  for  the  result  of  his  remedies.  His  only  contract 
is  to  treat  the  case  with  reasonable  diligence  and  skill.  If  more 
than  this  is  expected  it  must  be  expressly  stipulated  for.  .  .  . 
The  general  rule,  therefore,  is,  that  a  medical  man,  who  attends 
for  a  fee,  is  liable  for  such  want  of  ordinary  care,  diligence  or 
skill  on  his  part  as  leads  to  the  injury  of  his  patient.  To  render 
him  liable,  it  is  not  enough  that  there  has  been  a  less  degree  of 
skill  than  some  other  medical  man  might  have  shown,  or  a  less 
degree  of  care  than  even  himself  might  have  bestowed ;  nor  is 
it  enough  that  he  himself  acknowledged  some  degree  of  want  of 
care ;  there  must  have  been  a  want  of  competent  and  ordinarj' 
care  and  skill,  and  to  such  a  degree  as  to  have  led  to  a  bad 
result.  .  .  .  But  a  professed  physician  or  surgeon  is  bound  to 
use  not  only  such  skill  as  he  has,  but  to  have  a  reasonable 
degree  of  skill.  The  law  will  not  countenance  quackery ;  and 
although  the  law  does  not  require  the  most  thorough  education 
or  the  largest  experience,  it  does  require  that  an  uneducated, 
ignorant  man  shall  not,  under  the  pretence  of  being  a  well- 
qualified  physician,  attempt  recklessly  and  blindly  to  adminis- 
ter medicines  or  perform  surgical  operations.  If  the  practi- 
tioner, however,  frankly  informs  his  patient  of  his  want  of 
skill,  or  the  patient  is  in  some  other  way  fully  aware  of  it,  the 


AVERAGE   STANDARD    OF   SKILL   REQUIRED.  ol 

latter  cannot  complain  of  the  lack  of  that  which  he  knew  did 
not  exist."  ' 

Average  Standard  of  Skill  of  any  Professed  School  must 
be  Attained. — It  is  also  a  rule  that  one  who  professes  to  adhere 
to  a  particular  school  must  come  up  to  its  average  standard,, 
and  must  be  judged  by  its  tests,  and  in  the  light  of  the  present 
day.  Thus  a  physician  who  would  practise  the  reckless  and 
indiscriminate  bleeding  which  was  in  high  repute  not  very 
many  years  ago,  or  should  shut  up  a  patient  in  fever  and  deny 
all  cooling  drinks,  would  doubtless  find  the  old  practice  a  poor 
excuse  for  his  imbecility.  So,  if  a  professed  homoeopathist 
should  violate  all  the  canons  of  homoeopathy,  he  would  be 
bound  to  show  some  very  good  reasons  for  his  conduct,  if  it 
was  attended  with  injurious  effects.  Upon  many  points  of 
medical  and  surgical  practice  all  of  the  schools  are  agreed,  and 
indeed  common  sense  and  universal  experience  prescribe  some 
invariable  rules,  to  violate  which  may  generally  be  called  gross 
negligence.  Yet  the  patient  cannot  justly  complain  if  he  gets 
only  that  quality  and  kind  of  service  for  which  he  bargains.  If 
he  employs  a  cheap  man,  he  must  expect  cheap  service.  Puf- 
fendorf,  in  his  "Law  of  Nature  and  Nations,"  observes:  "We 
read  a  pleasant  story  of  a  man  who  had  sore  eyes  and  came  to 
a  horse-doctor  for  relief.  The  doctor  anointed  his  eyes  with  the 
same  ointment  he  used  among  his  horses,  upon  which  the  man 
falls  blind,  and  the  cause  is  brought  before  the  judge,  who 
acquits  the  physician.  For  if  the  fellow,  says  he,  had  not  been 
an  ass  he  had  never  applied  himself  to  a  horse-doctor."  See 
also  Jones  on  Bailments,  100;  1  Field's  "  Lawyers' Briefs,"  sub. 
Bailments,  Sec.  573;  Musser  ■?;.  Chase,  29  Ohio  St.,  577;  Lan- 
phier  v.  Phipos,  8  Carr.  &  Payne,  478. 

Degree  of  Care  and  Skill  Used  a  Question  of  Fact. — In 

'See  also  "Field's  Medico- Legal  Grover,  28  Me.,  97.  Illinois,  Mac- 
Guide,"  208-210,  where  the  follow-  Nevins  v.  Lowe,  40  111.,  209.  Kan- 
ing  cases  are  cited  as  sustaining  sas,  Teft  v.  Wilcox,  6  Kan.,  4f). 
this  doctrine  :  New  York,  Carpenter  Massachusetts,  Com.  v.  Thompson, 
V.  Blake,  60  Barb.,  488;  same  case  6  Mass.,  134;  Small  ■».  Howard, 
on  appeal,  75  N.  Y.  Court  of  Ap-  138  Mass.,  131,  35  Am.  Rep.,  363. 
peals,  12.  Connecticut,  Landon  v.  Pennsylvania,  Potter  v.  Warner,  91 
Humphrej',  9  Conn.,  209.  Iowa,  Pa.  St.,  362,  36  Am.  Rep.,  668. 
Smothers  ■».  Hawks,  34  la. ,  286.  In-  Wisconsin,  Reynolds  «.  Graves,  3 
diana.  Long  v.  Monison,  14  Ind. ,  Wis. ,  416.  Vermont,  Briggs  v. 
595.  Maine,  Leighton  v.  Sargeant,  Taylor,  28  Vt. ,  180. 
27  Me.  (7  Fost.),  468;   Howard   v. 


32  LEGAL   STATUS   OF   PHYSICIANS— BECKER. 

an  action  at  law,  whether  brought  by  a  physician  to  recover 
for  his  services,  or  by  a  patient  to  recover  for  malpractice  or 
neglect,  it  is  always  a  question  of  fact,  to  be  determined  by  the 
jury  under  proper  instructions  as  to  the  measure  of  care  and 
.skill  required,  whether  or  not  the  physician  has  in  a  given  case 
used  that  degree  of  care  and  displayed  that  amount  of  skill 
which  might  reasonably  be  expected  of  a  man  of  ordinary 
ability  and  professional  skill.  These  same  rules  apply  to  the 
surgeon.  He  must  possess  and  exercise  that  degree  of  knowl- 
edge and  sense  which  the  leading  authorities  have  announced, 
as  a  result  of  their  researches  and  experiments  up  to  the  time, 
or  within  a  reasonable  time  before,  the  issue  or  question  to  be 
determined  is  made.' 

Rule  in  Leading  Case  of  Lanphier  v.  Phipos. — In  the 
case  of  Lanphier  v.  Phipos,  8  C.  &  P.,  478,  already  cited.  Chief 
Justice  Tyndall  enunciated  the  rule  as  to  the  degree  of  skill 
required  of  a  physician  or  surgeon,  which  has  been  followed  by 
all  the  courts  since  then.  He  said :  "  Every  person  who  enters 
into  a  learned  profession  undertakes  to  bring  to  the  exercise  of 
it  a  reasonable  degree  of  care  and  skill.  He  does  not,  if  he  i& 
an  attorney,  undertake  at  all  events  to  gain  the  cause,  nor 
does  a  surgeon  undertake  that  he  will  perform  a  cure ;  nor  does 
the  latter  undertake  to  use  the  highest  possible  degree  of  skill, 
as  there  may  be  persons  of  higher  education  and  greater  advan- 
tages than  himself;  but  he  undertakes  to  bring  a  fair,  reasona- 
ble and  competent  degree  of  skill.  And  in  an  action  against 
him  by  a  patient,  the  question  for  the  jury  is  whether  the  injury 
complained  of  must  be  referred  to  a  want  of  proper  degree  of 
skill  and  care  in  the  defendant,  or  not.  Hence  he  is  never  pre- 
sumed to  engage  for  extraordinary  skill,  or  for  extraordinary 
diligence  and  care.  As  a  general  rule,  he  who  undertakes  for 
a  reward  to  perform  any  work  is  bound  to  use  a  degree  of  dili- 
gence, attention  and  skill,  adequate  to  the  performance  of  his 
undertaking;  that  is,  to  do  it  according  to  the  rules  of  the  art; 
spondet  peritiam  art  is.  And  the  degree  of  skill  arises  in 
proportion  to  the  value  and  delicacy  of  the  operation.     But  he 

1  See  Shear.    &  Redf.    on  Negli-  Baker,  2  Willes  (Eng.),  259;  Ordro- 

gence,  440 ;  Elwell  on  Malpractice,  naux  on  Jurisp.  of  Med. ,  pp.   29  et 

55;  Carpenters  Blake,  supra;  Rex  pass.;  20  Am.  Law  Rev. ,  82. 
V.  Long,  4  C.  &P.,     422;   Slater  «. 


COMMUNICATIONS  BETWEEN  PATIENT  AND  PHYSICIAN.         33 

is  in  no  case  required  to  have  more  than  ordinary  skill,  for  he 
does  not  engage  for  more." 

Physician  Must  Instruct  Patient  how  to  Care  for  Him- 
self, etc. — A  corollary  of  these  rules  is,  that  the  physician  must 
give  proper  instruction  to  his  patient  how  to  take  care  of  him- 
self, how  to  manage  a  diseased  or  injured  member,  when  and 
how  to  take  any  medicines  that  may  be  prescribed,  what  diet  to 
adopt,  and  that  in  case  the  physician  fails  to  give  these  instruc- 
tions he  is  liable  for  any  injuries  that  result  from  this  failure. 
Carpenter  v.  Blake,  supra. 

Patient  Must  Inform  Physician  Fully  Concerning  his 
Case — His  Communications  Privileged. — On  the  other  hand, 
as  we  have  already  stated,  the  patient  owes  the  duty  to  his 
physician  of  informing  him  fully  of  all  the  varied  sj'mptoms 
of  his  disease,  or  the  circumstances  attending  his  injury,  and 
to  freely  and  with  due  confidence  answer  all  questions  concern- 
ing his  past  history  which  would  tend  to  throw  any  light  upon 
his  present  condition.  To  battle  with  the  occult  forces  which 
play  so  important  a  part  in  determining  the  course  or  conse- 
quences of  disease,  it  is  absolutely  essential  that  the  physician 
should  know  all  that  is  possible  to  be  known  of  the  patient's 
history,  and  of  the  history  of  the  patient's  family.  As  we  shall 
see  later  on,  all  such  communications  are,  in  most  of  the  States 
of  the  Union  and  elsewhere,  by  statutory  enactment  made  priv- 
ileged, and  without  the  consent  of  the  patient  the  phj^sician  or 
surgeon  is  absolutel}'  forbidden  to  divulge  any  communication 
or  information  which  he  receives  in  order  to  enable  him  to 
prescribe.  This  rule  applies  equally  whether  the  physician  or 
surgeon  is  acting  for  hire  or  is  treating  the  person  as  a  charity 
patient,  and  it  has  been  extended  by  construction  by  the  courts 
in  some  States,  so  as  to  include  examinations  made  by  jail 
physicians  or  other  physicians  sent  by  the  prosecuting  oflBcials 
of  the  State  to  examine  a  prisoner,  for  purpose  of  giving  evi- 
dence, but  who  allowed  the  prisoner  to  suppose  that  they  were 
there  simpl}'  to  treat  him  in  their  professional  capacity.  People 
V.  Murphy,  101  N.  Y.,  126.  At  the  same  time  the  courts  have 
been  careful  to  make  an  exception  in  the  case  of  advice  given 
for  the  purpose  of  enabling  the  person  receiving  the  advice  to 
commit  a  crime,  and  of  any  information  received  by  the  phy- 
sicians while  the  persons  asking  for  it  were  engaged  in  a  crim- 
3 


34  LEGAL   STATUS   OF   PHYSICIANS— BECKER. 

inal  attempt.  All  of  these  interesting  questions  will  be  exam- 
ined and  treated  of  at  length  hereafter, ' 

Conditions  of  Contract  Between  Physician  and  Patient 
Further  Considered. — It  has  been  observed  that  the  contract 
between  the  physician  and  j^atient  may  be  conditional  or  un- 
conditional. By  this  it  is  meant  that  limitations  upon  the 
reciprocal  obligations  between  them  may  be  imposed,  or  exten- 
sions of  such  obligations  made,  by  special  agreement.  The 
physician  may  contract  to  cure,  and  may  make  the  cure  a  con- 
dition precedent  to  receiving  any  reward  for  his  services  or 
medicaments,  and  a  breach  of  such  a  contract  will  be  enforced 
by  the  courts  as  a  bar  to  an  action  for  services  rendered  or 
medicines  furnished.  The  patient  may  agree  to  come  to  the 
physician's  home  or  to  a  hospital  or  other  place  agreed  upon 
between  them,  for  the  purpose  of  being  treated,  or  of  being 
operated  upon  by  a  surgeon,  and  a  failure  to  perform  such  an 
agreement  on  the  part  of  the  patient  absolves  the  medical  man 
from  carrying  out  his  agreement  to  treat  the  patient.  In  the 
case  already  suggested  of  a  request  by  the  medical  man  for 
information  as  to  the  patient's  past  history,  or  that  of  the 
patient's  family,  or  the  circumstances  concerning  the  injury  or 
symptoms  of  the  disease,  if  the  patient  should  give  false  infor- 
mation, or  should  wilfully  neglect  to  give  true  information,  the 
physician  would  have  a  right,  upon  giving  reasonable  and  due 
notice,  and  opportunity  to  employ  some  one  else,  as  alreadj' 
intimated,  to  decline  to  proceed  further  with  his  care  of  the 
case,  and  might  sue  and  recover  pay  for  the  services  rendered. 

Physicians  Cannot  Contract  that  they  shall  Not  be  Re- 
sponsible for  Want  of  Ordinary  Care  and  Skill. — An  impor- 
tant and  salutary  exception  to  the  general  rule  that  all  parties 
maj^  contract  freely  as  between  themselves  stipulations  measur- 
ing their  reciprocal  obligations,  doubtless  applies  to  the  rela- 
tions between  physician  and  patient.  It  is  an  exception  which 
has  been  applied  to  the  contract  relations  existing  between  a 
common  carrier  and  a  shipper  or  a  passenger.     This  is  that 

'  On  the  points  here  suggested  of.  Y. ,  56  ;  People  v.  Murphy,  23  N.  Y. 

Edington  v.  Life  Ins.  Co.,  67  N.  Y.,  Weekly  Digest,  43 ;  same  case,  101 

185;  same  case,  77  N.  Y.,  564;  Grat-  N.   Y.,  126;  Hunn -w.  Hunu,  1   T.  & 

tan  V.  Life  Ins.  Co.,  80  N.  Y..  281;  C,  499;  Piersou  v.  The  People.  79 

Dilleber  v.  Life  Ins.  Co. ,  87  N.  Y. ,  N.  Y. ,  432-435  ;    People  v.    Carlyle 

79  ;  Westover  v.  Life  Ins.  Co. ,  99  N.  Harris,  136  N.  Y. ,  424. 


CONTRACT   BETWEEN   PHYSICIAN  AND    PATIENT.  35 

persons  contracting  to  perform  services  which  are  to  a  certain 
extent  public  in  their  nature,  and  which,  as  in  the  case  of  the 
common  carrier  or  in  the  case  of  the  physician  or  surgeon,  are 
founded  upon  conventional  relations,  and  affect  the  public  wel- 
fare, are  not  permitted,  from  reasons  of  public  policj^  to  con- 
tract for  a  release  or  escape  from  liability  arising  out  of  their 
own  negligence  or  wrong.  In  short,  a  physician  or  surgeon 
cannot  contract  with  a  patient  that  the  patient  shall  waive  any 
claim  for  damages  growing  out  of  his  want  of  ordinary  care  and 
skill.  Nevertheless,  the  physician  or  surgeon  may  frankly  in- 
form his  patient  of  his  want  of  knowledge  and  experience  as  to 
the  particular  kind  of  treatment  required  by  any  special  and 
unusual  disease  or  injury.  If  after  full  information  on  this 
point,  and  full  opportunity  to  employ  some  one  else,  the  patient 
insists  that  the  physician  or  surgeon  go  on  with  such  treatment 
as  he  is  able  to  give  to  the  case,  and  injuries  result  which  a 
more  skilful  and  experienced  practitioner  might  have  avoided, 
it  is  probable  that  the  courts  would  hold  that  the  practitioner 
was  not  liable  under  such  circumsta,nces,  or  that  such  circum- 
stances could  be  pleaded  in  mitigation  of  damages.  But  it 
would  be  the  duty  of  the  practitioner  in  such  a  case  to  be  ex- 
ceedingly careful  in  performing  any  surgical  operations,  and  not 
administer  any  powerful  drugs  with  the  strength  and  medicinal 
qualities  of  which  he  was  not  acquainted.  If  he  should  assume 
to  perform  such  operations  or  administer  such  drugs  instead  of 
confining  himself  to  modifying  the  ravages  of  disease  by  the 
use  of  well-known  simple  remedies,  or  protecting  against  the 
consequences  of  severe  injury  by  the  use  of  ordinary  antiseptic 
dressings  and  treatment,  he  would  no  doubt  be  liable  for  any 
resulting  damage,  and  could  not  recover  pay  for  his  service. 

Experiments  Not  to  be  Tried  on  Patients — This  Rule  Ap- 
plies to  Charity  Patients. — For  like  reasons  of  public  policy 
it  has  been  held  that  a  physician  has  no  right  to  try  experiments 
on  his  patient.'  In  this  respect  a  charity  patient  will  be  pro- 
tected by  law  and  compensated  for  damages  received  from  ex- 
periments on  his  health  and  person,  just  as  much  as  a  person 
from  whom  a  large  fee  could  be  expected.  Humanity  and 
public  policy  both  forbid  that  experiments  should  be  tried  upon 
one  class  of  patients  any  more  than  another.  However  this 
'  Patten  v.  Wiggin,  51  Me. ,  594. 


36  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

maj^  be,  in  a  case  of  extreme  danger,  where  other  resorts  have 
failed  and  everything  else  done  that  could  reasonably  be  re- 
quired, and  if  the  patient  and  his  family  consent  after  full  in- 
formation of  the  dangerous  character  of  the  operation,  or  the 
unknown  qualities  and  powers  of  the  drug  to  be  administered, 
the  practitioner  would  be  justified  and  protected  if  some  new 
methods  of  treatment  not  entirely  developed  or  known  to  the 
profession,  but  supposed  to  be  eflQcacious,  should  be  adopted, 
although  the  result  might  prove  unfavorable.  In  such  a  case, 
however,  it  would  be  extremely  perilous  for  the  phj^sician  to 
stand  upon  his  own  judgment  alone.  He  should  consult  the  best 
talent  in  his  profession  available,  and  abide  by  the  judgment  of 
his  colleagues  or  a  fair  majority  of  them;  and  even  then 
should  apply  to  his  course  of  action  the  maxim.  When  in  doubt 
run  no  risks;  better  let  a  patient  perish  from  disease  or  injury, 
than  while  attempting  uncertain  experiments  with  the  surgeon's 
knife  or  the  use  of  dangerous  drugs.  The  safe  rule  is  to  take 
no  chances,  unless  there  is  a  consensus  of  judgment  of  several 
physicians.  It  maybe  objected  that  if  no  experiments  are  tried 
no  new  medicines  or  surgical  devices  could  be  discovered,  or 
their  effects  observed.  The  answer  to  this  objection  is  that 
vivisection,  and  other  experiments  upon  live  animals,  permit  of 
experimentation  to  a  considerable  degree,  and  often  effectually 
point  out  the  proper  course  of  treatment  of  the  human  subjects. 
In  the  case  of  drugs  and  medicines  the  practice  is  well  known 
of  physicians  trying  the  effects  thereof  upon  their  own  persons, 
in  their  zeal  and  anxiety  to  give  to  the  world  new  discoveries. 
But,  as  heretofore  observed,  the  law  does  not  recognize  the  right 
of  the  medical  or  surgical  practitioner  to  tamper  with  his 
patients'  health  by  the  use  of  untried  experiments,  without 
imposing  upon  the  practitioner  liability  for  all  injuries  proxi- 
mately resulting  from  their  use.  All  of  such  matters  will, 
however,  fall  more  properly  under  consideration  when  the  lia- 
bility of  the  physician  and  surgeon  for  malpractice  is  considered. 


CHAPTER   IV, 

OF  THE   LEGAL  RIGHT   OF  PHYSICIANS   AND   SURGEONS 
TO  RECOVER   COMPENSATION   FOR   SERVICES. 

Liability  to  Pay  for  Services. — An  important  matter  for 
physicians  and  surgeons  is  the  question  as  to  who  is  responsi- 
ble, or  liable  to  pay  for  their  services.  If  there  is  an  express 
contract  this  question  does  not  arise;  but  in  most  instances 
the  person  performing  the  services  renders  them  upon  call,  and 
it  is  necessary  for  him  to  understand  his  legal  right  to  recover 
pay  for  services  in  the  absence  of  an  express  contract. 

Person  Treated,  and  not  Person  calling  in  Physician,  Em- 
ploys Him  and  is  Liable. — In  the  first  place,  it  must  be  stated 
as  a  general  proposition  that  the  person  for  whom  the  services 
are  actually  rendered,  or  upon  whom  the  operation  is  performed, 
is  bound  to  pay  for  them,  if  otherwise  capable  in  law  of  mak- 
ing contracts  and  incurring  obligations.  And  secondl}^,  that 
one  who  calls  a  physician  or  surgeon  to  attend  a  patient  is  not 
presumed  to  have  contracted  to  pay  for  the  services  rendered, 
unless  his  relations  with  the  patient  are  such  that  he  would  be 
obligated  in  law  to  pay,  even  if  he  had  not  himself  called  in  the 
medical  man. 

In  the  first  case  it  is  presumed  that  the  patient  is  liable, 
because  he  receives  the  benefit  of  the  services,  and  nothing  less 
than  a  distinct  understanding  that  he  was  not  to  pay  will 
relieve  him  from  this  obligation. 

31arried  Women  and  Infants  Generally  Not  Liable. — 
"Where  such  a  person  is  a  married  woman,  unless  the  case  arises 
in  States  or  countries  where  married  women  have  been  declared 
by  statutes  to  be  liable  the  same  as  if  single,  this  rule  does  not 
obtain.  Nor  is  an  infant  personally  liable  when  he  is  living  with 
his  parent  or  guardian.  Hull  v.  Connelly,  3  McCord  (S.  C),  0 ; 
Klein  ?;.  La  Amoreaux,  2  Paige  Ch.,419;  Atchinson  ■?'.  Bruff, 
50  Barb.,  384;  Wilcox  v.  Smith,  2G  Barb.,  341.  But  the 
contract  of  an  infant  for  medicine  and  medical  attendance  is 

37 


38  LEGAL  STATUS   OF   PHYSICIANS — BECKER. 

deemed  a  contract  for  necessaries,  and  will  be  held  valid  and 
enforced  against  his  estate  if  there  is  no  person  standing  in  loco 
parentis  who  can  be  held  liable.  3  Barn.  &  Cress.,  484;  2 
Kent  Com.,  236.  In  cases  when  the  parent  of  the  infant  or  the 
husband  of  the  married  woman  is  liable,  this  liability  obtains 
because  the  services  rendered  are  deemed  necessary,  and  fall 
within  the  common-law  obligation  of  such  persons  to  provide 
and  pay  for  necessaries  for  those  whom  they  are  bound  to  sup- 
port and  maintain. 

Burden  upon  Physicians  Treating  Minors  to  Show  Ser- 
vices Necessary. — But  even  in  such  cases  the  burden  is  upon 
the  person  performing  the  services  to  show  that  they  were  nec- 
essary, and  it  is  his  duty  to  know,  or  learn,  the  true  legal  status 
of  the  patient,  and  the  true  legal  relations  of  the  patient  to  the 
person  other  than  the  patient  froin  whom  payment  is  to  be 
claimed.  As  said  in  the  case  of  Crain  v.  Baudouin  (55  N. 
Y.,  256-261),  "in  the  case  of  minor  children  even,  the  law  im- 
poses this  duty  upon  those  who  would  furnish  them  with  nec- 
essaries, relying  upon  the  credit  of  their  fathers,  and  seeking 
to  charge  them.  (Hunt  v.  Thompson,  3  Scam.,  179;  Van 
Valkinburgh  v.  Watson,  13  J.  R.,  480)."  "  A  fortiori,  it  is  so 
in  the  case  of  an  adult  married  daughter  living  with  her  hus- 
band." And  as  to  the  liability  of  the  husband  of  a  married 
woman  in  the  absence  of  statute  giving  her  legal  capacity  to 
contract  and  charge  her  separate  estate.  Consult  Moody  v.  Os- 
good, 50  Barb.,  628;  Potter  v.  Virgil,  67  Barb.,  578  ;  Crain 
V.  Baudouin,  55  N.  Y.,  256-261. 

Mother  of  Infant  probably  Liable  after  Father' s  Death. 
— It  has  been  a  much  disputed  question  whether  after  the  father's 
death  the  mother  becomes  responsible  for  necessaries  furnished 
for  her  minor  children.  The  theory  of  law  upon  which  a  father 
is  made  liable  proceeds  upon  the  ground  that  he  is  bound  to 
support  the  child  and  has  a  right  to  the  child's  services  during 
its  minority.'  It  has  been  held  that  the  mother  after  the 
death  of  the  father  is  entitled  to  those  services.  Campbell  v. 
Campbell,  3  Stock.  (N.  J.),  265;  Cain  v.  Dewitt,  8  Iowa,  116; 
Furman  v.  Van  Size,  56  N.  Y.,  435-439,  disapproving  Bentley 
V.  Richtmeyer  (4  Comstock,  38),  and  approving  In  re  Rj^der, 
11  Paige,  185.  If  she  is  entitled  to  the  services  of  her  child, 
^  See  on  this  question  also  Bigelow's  "  Leading  Cases, "  on  Torts,  295-303. 


LIABILITY   FOR  PHYSICIAN'S   FEES.  30 

she  must  be  bound  to  support  and  care  for  it ;  and  so  it  was 
held  in  Furman  v.  Van  Size  cited  above. 

Estates  of  Insane  Persons  Liable  in  a  Proper  Case. — 
Persons  of  unsound  mind  are  liable  for  necessaries  furnished 
for  their  benefit,  and  can  be  made  to  pay  therefor  at  reasona- 
ble and  proper  rates,  but  they  cannot  make  contracts  for  a 
specific  rate.  It  is  always  a  question  of  fact  as  to  what  sum 
should  be  charged  against  their  estates,  if  they  have  any. 

Master  Not  Liable  for  Services  Rendered  Servant  ivithout 
Special  Contract. — In  the  case  of  master  and  servant,  while  at 
common  law  as  between  a  master  and  servant  the  master  was 
bound  to  provide  medicine  and  food  for  the  servant  when  the 
servant  was  an  inmate  of  the  master's  house,  this  is  an  obliga- 
tion which  a  third  person  could  not  enforce,  and  the  master  can 
only  be  held  liable  for  services  rendered  to  the  servant,  upon 
proof  of  a  specific  contract  with  him  to  pay  for  them. 

Case  of  Grain  v.  Baudouin  Considered. — The  case  of  Grain 
V.  Baudouin,  supra,  affox-ds  an  interesting  discussion  before  the  high- 
est court  of  New  York  State,  as  to  the  question  as  to  how  far  a 
father  calling  a  physician  for  an  adult  child  for  whom  he  is  not 
bound  to  provide,  although  lying  sick  at  the  father's  house,  can  be 
held  liable  for  the  services  rendered  upon  such  call.  In  that  case 
the  plaintiff  attended  as  a  physician  upon  the  daughter  of  the  de- 
fendant, who  was  sick  at  his  house.  The  daughter  was  of  full  age, 
married  and  living  with  her  husband,  but  was  brought  from  that  of 
her  husband  to  that  of  her  father  in  order  that  she  might  be  under  the 
care  of  her  mother.  Defendant  was  present  when  plaintiff  made  his 
calls,  gave  the  latter  a  history  of  the  patient's  illness,  and  received  di- 
rections as  to  her  treatment.  He  told  others  of  the  frequency  and 
length  of  the  plaintiff's  visits,  and  of  his  opinion  of  the  case,  without 
any  disclaimer  of  liabilit3\  The  Court  held,  however,  that  these  facts 
were  insufficient  to  imply  a  promise  on  the  father's  part  to  pay  for  the 
services,  and  that  the  additional  facts  that  the  defendant  consented  to 
the  calling  in  of  a  consulting  physician,  and  that  a  bill  was  sent  in  by 
the  plaintiff,  unless  acknowledged  and  acquiesced  in  by  defendant,  or 
that  he  had  before  this  employed  other  physicians,  were  also  insufficient 
to  raise  an  implication  of  law  of  such  a  promise  to  pay.  The  plaintilf 
relied  in  his  argument  upon  the  fact  that  the  patient  was  a  daughter  of 
the  defendant,  but  the  Coui^t  held  that  any  presumption  which  might 
arise  from  this  had  the  daughter  been  under  age,  was  overcome  by  the 
fact  that  she  was  past  a  majority,  and  was  married  and  lived  with  her 
husband  and  children.     The  plaintiff  also  relied  to  support  his  cause 


40  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

of  action  upon  the  interest  exhibited  by  the  defendant  in  the  course  of 
treatment  pursued,  and  the  other  facts  as  to  the  presence  of  the  defend- 
ant when  the  plaintiff  made  his  professional  calls  alone  and  in  con- 
sultation ;  his  receiving  du'ections  as  to  treatment ;  his  recognition  to 
others  of  the  fact  that  the  plaintiff  was  in  attendance ;  his  reciting  to 
others  a  knowledge  of  the  frequency  and  length  of  the  visits  of  plaintiff 
without  any  disclaimer  on  the  part  of  the  defendant  of  liability.  The 
Court  said  as  to  these  facts  :  "  It  is  true  that  particular  acts  will  some- 
times give  rise  to  particular  obligations,  duties  and  liabilities.  But  the 
party  whose  acts  are  thus  to  affect  him  must  be  in  such  predicament 
as  that  those  acts  have,  of  legal  necessity,  a  significance  attached  to 
them,  at  the  time,  which  he  may  not  afterward  repel.  ...  It  has 
been  held  that  a  special  request  by  a  father  to  a  physician  to  attend 
upon  his  son,  then  of  full  age  but  lying  sick  at  the  father's  house, 
raised  no  implied  promise  on  the  part  of  the  father  to  pay  for  the  ser- 
vices rendered."  See  Boyd  v.  Sappington,  4  Watts  (Pa.),  247;  and  so 
in  Veitch  v.  Russell,  3  Ad.  &  Ell.  (N.  S.),  927,  it  is  said  :  "A  physiciai;i 
attends  in  every  case  on  request ;  that  fa,ct  alone  is  not  enough  for  the 
inference  of  a  special  contract ; "  and  see  Sellen  v.  Norman,  4  Carr.  & 
P.,  284.  Still  less  where  there  has  been  no  special  request  by  the  father 
to  the  physician,  and  no  more  than  acquiescence  in  his  calls.  As  it 
would  be  unnatural  for  the  parent  of  an  invalid  child,  though  legally 
emancipated,  or  for  an  intimate  and  confidential  friend  of  hers,  not  to 
know  the  rise  and  course  of  her  malady,  not  to  be  interested  in  the 
state  of  it  as  disclosed  at  any  time  to  skilled  inspection,  not  to  be  so  anx- 
ious as  to  be  in  waiting  when  scientific  skill  was  to  be  applied  for  its 
cure,  not  to  be  ready  to  receive  directions  for  treatment  in  the  inter- 
vals ;  so  it  is  not  to  be  implied  in  the  one  case  more  than  in  the  other 
that,  from  these  manifestations,  because  unaccompanied  with  an  ex- 
press repudiation  of  liability,  a  liability  may  be  implied.  They  are  to 
be  referred  to  natural  affection  and  friendly  sympathj",  rather  than  to  an 
acquiescence  in  the  rendition  of  a  personal  benefit,  or  counted  as  acts 
done  under  a  sense  of  legal  obligation."  The  Court  further  said  that 
"even  if  it  should  be  assumed  that  the  usage  exists  that  the  physician 
called  to  consult  with  him  who  is  in  attendance,  with  the  consent  of 
the  person  who  has  employed  the  latter,  is  in  contemplation  of  law  in 
the  hire  of  that  person,  still  the  assent  of  the  defendant  to  the  calling 
in  of  the  consulting  physician,  and  his  expression  of  desire  to  be  present 
when  he  came — until  he  is  shown  to  have  employed  the  plaintiff — is  a 
basis  too  weak  for  an  implication  of  law,  that  he  promised  to  pay  his  con- 
sultation fees.  Still  less  it  is  a  fact  from  which  to  imply  a  promise  to 
pay  the  plaintiff."  This  case  is,  however,  close  to  the  border  line,  and 
it  may  be  well  criticised  and  denied  its  apparent  full  weight  of  author- 
ity, notwithstanding  the  very  great  learning  and  ability  of  the  learned 
Judge  Folger,  who  wrote  the  opinion,  upon  the  ground  that  it  appears 


LIABILITY  OF  THIRD  PERSONS  CALLING  A  PHYSICIAN.  41 

that  the  father  had  as  a  witness  expressly  denied  calling  in  the  plaintiff 
or  authorizing  anybody  to  call  him  in,  or  authorizing  the  employment 
of  a  consulting  physician,  and  that  on  the  trial  the  Court  had  found 
upon  the  whole  testimony  in  the  case  that  the  defendant  had  never 
employed  the  plaintiff.  Taking  the  decision  as  a  whole  it  cannot  be 
regarded  as  determining  thai  upon  such  a  set  of  circumstances  as  is 
there  disclosed,  the  father  could  not  in  any  event  have  been  held  liable, 
but  rather  that  the  trial  court  having  found  upon  the  whole  testimony 
that  the  defendant  was  not  liable,  having  witnesses  before  it  fully 
able  to  judge  of  their  capability,  the  appellate  court  could  not  say  as  a 
matter  of  law  that  a  finding  in  favor  of  the  defendant  should  be  over- 
ruled. This  case  is  considered  here  at  some  length  chiefly  for  the  pur- 
pose of  affording  an  illustration  to  physicians  and  surgeons  which  will 
suggest  to  them  the  advisability  of  care  in  ascertaining  in  all  cases  who 
is  responsible  for  their  charge  for  services.  See  also  Bradley  v.  Dodge, 
45  How  Pr.  (N.  Y.),  57;  Smith  v.  Riddick,  5  Jones  (N.  C),  42. 


Liability  of  Third  Persons  Calling  a  Physician — 
General  Rule. 

As  to  liability  for  services  rendered,  when  the  medical  man 
is  called  by  one  person  to  attend  another,  it  may  be  stated  as  a 
general  rule  that  in  order  to  create  such  a  liability  it  must 
appear  that  the  person  calling  either  actuallj^  intended  to  be- 
come responsible,  or  acted  in  such  a  manner  that  the  phj^sician 
was  led  to  suppose  that  he  so  intended. 

Liability  of  Railway  Company  Calling  Physician  in 
Case  of  Accident  to  Employees,  etc. — Another  more  trouble- 
some question  has  arisen  where  physicians  and  surgeons  have 
been  called  in  by  employees  of  a  railway  company  in  case  of 
sudden  accident  or  injurj^  In  one  case  in  New  York,  the 
Superior  Court  of  New  York  City  held,  that  although  the  gen- 
eral superintendent  of  a  railroad  company  testified  that  he  had 
general  authority  to  hire  and  discharge  men,  and  that  he  had 
employed  a  physician,  the  railroad  company"  was  not  liable.' 

This  doctrine  seems  to  be  opposed  to  the  weight  of  authority.  See 
cases  collated  in  Vol.  18,  "Am.  and  Eng.  Cyclopaedia  of  Law,"'  p.  434  et 
seq.,  some  of  which  are:  Toledo,  etc.,  R.  R.  Co.  v.  Rodrigues,  47  111., 
188;  Same  v.  Prince,  50  111.,  26 ;  Indianapolis,  etc.,  R.  R.  i\  Morris,  67 

'Stevenson  v.  The  New  York,  Cases,  343;  Cincinnati,  etc.,  R.  R. 
etc. ,  Railroad  Co. ,  3  Duer,  341  ;  Co.  v.  Davis,  43  Am.  &  Eng.  R.  R. 
same   case,     1    Am.    &  Eng.  R.  "R.      Cases,  459. 


42  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

111.,  295  ;  Cairo,  etc.,  R.  R.  Co.  v.  Mahoney,  82  111.,  73 ;  Atchison,  etc., 
R.  R.  V.  Beecher,  24  Kansas,  228. 

Same  Rule  does  Not  Prevail  in  United  States  in  Case  of  Acci- 
dents to  Passengers. — The  cases  just  noted  were  all  cases  of  employees. 
In  the  cases  of  injured  passengers  it  has  been  doubted  whether  the  same 
rule  applied,  some  State  courts  holding  that  in  that  case  there  is  no 
obligation  to  furnish  medical  and  surgical  attendance,  but  that  the 
physician  attending  must  look  to  the  persons  whom  they  attended. 
Union  Pacific  R.  R.  Co.  v.  Beatty,  35  Kansas,  265  ;  Brown  v.  Missouri, 
67  Missouri,  122. 

Different  in  England. — In  England  a  different  rule  prevails — one 
more  humane  and  in  consonance  with  the  moral  obligation  imposed  by 
the  relationship  of  the  parties.  In  Walker  v.  The  Great  Western  R.  R. 
Co.,  a  recent  case  (Law  Reports,  2  Exch.,  228),  Chief -Justice  Kelley,  in 
the  course  of  the  argument,  made  this  remark  :  ' '  Must  a  board  be  con- 
vened before  a  man  who  has  his  legs  broken  can  have  medical  at- 
tendance ? " 

But  in  Cox  V.  The  Midland  Counties  R.  R.  Co.  (3  Wellsby,  H.  &  G., 
268),  the  station  master,  employed  as  the  chief  officer  of  the  passenger 
and  other  departments,  called  in  a  surgeon  to  perform  an  operation 
upon  a  passenger  injured  by  a  train.     The  road  was  held  not  liable. 

On  the  other  hand,  in  Langan  v.  Great  Western  R.  R.  Co.  (30  Law 
Times,  N.  S.,  173),  a  sub-inspector  of  railway  police  was  held  to  have 
implied  power  to  employ  a  surgeon  for  an  injured  employee.  But  i)i 
Arkansas  an  attorney  for  a  railroad  company  was  held  not  authorized 
to  do  so.    St.  Louis,  etc.,  R.  R.  Co.  v.  Hoover,  53  Ark.,  377. 

Doctrine  in  Indiana  the  More  Sensible  One. — The  more  sensible 
doctrine  seems  to  be  established  in  this  country,  in  the  State  of  Indiana 
at  least,  in  the  case  of  Terre  Haute  R.  R.  Co.  v.  McMurray  (98  Ind., 
358),  in  which  the  Court  held  that  where  there  was  great  necessity  for 
the  employment  of  a  surgeon,  the  conductor  of  a  train  has  authority  to 
employ  the  surgeon,  if  the  conductor  is  the  highest  officer  in  rank  on 
the  ground  at  the  time.  But  in  that  case  the  Court  expressly  states 
tliat  this  liability  grows  out  of  the  exigencies  of  the  case ;  not  out  of 
any  theory  of  general  authority. 

Authority  of  Railroad  Physician  to  Employ  Nurses,  etc. ,  Doubt- 
ful.— It  has  also  been  disputed  whether  the  authority  of  the  company's 
physician  extended  far  enough  to  render  the  company  liable  for  ser- 
vices performed  by  nurses  employed  by  him,  or  for  board  and  lodging 
engaged  by  him  for  injured  employees.  In  Bingham  v.  Chicago,  etc., 
R.  R.  Co.  (79  Iowa,  534),  it  was  held  that  the  authority  was  sufficient, 
but  in  that  case  testimony  appeared  tending  to  show  that  an  agent  of 
the  company  who  had  authority  to  employ  the  physician  had  author- 
ized him  to  employ  two  nurses.  The  converse  doctrine — namely,  that 
the  fact  that  a  physician  of  the  company  was  authorized  to  buy  medi- 


LIABILITY  OF  THIRD  PERSONS  CALLING  A  PHYSICIAN.        43 

cines  on  the  credit  of  the  company  does  not  authorize  the  inference 
that  he  has  power  to  render  the  company  liable  by  a  contract  for  board 
and  nursing  of  a  person  injured  on  the  company's  road — was  held  in 
Maber  v.  The  Chicago,  etc.,  R.  R.  Co.,  75  Missouri,  495  ;  Brown  v.  The 
Missouri  R.  R.,  67  Missouz-i,  122.  To  the  same  effect,  see  Louisville, 
etc.,  R.  R.  Co.  V.  McVeigh,  98  Ind.,  391 ;  Cooper  v.  N.  Y.  C.  &  C,  6 
Hun,  276 ;  and  St.  Louis,  etc.,  R.  R.  Co.  v.  Hoover,  53  Arkansas,  377. 
2  Redfield  on  Railways,  114  : 

On  the  other  hand,  where  a  physician  and  surgeon  has  been  duly 
employed  by  a  sub-officer  or  servant  of  the  railroad  company,  ratifica- 
tion of  this  employment,  by  those  having  authority  to  employ  him 
and  to  render  the  company  liable,  will  be  inferred  from  slight  circum- 
stances. 

Such  was  the  case  of  Louisville  R.  R.  Co.  v.  McVeigh,  which  has 
been  cited. 

And  in  another  case  where  information  of  the  fact  of  the  employ- 
ment had  been  conveyed  to  the  company's  general  manager,  and  he 
had  neglected  and  omitted  to  repudiate  the  employment  or  to  terminate 
it,  and  the  surgeon  went  on  and  performed  services,  it  was  held  that 
from  these  facts  a  ratification  will  be  inferred.  Indianapolis  R.R.  Co. 
i\  Morris,  supra.  See  also  Toledo,  etc.,  R.  R.  Co.  v.  Rodrigues,  sti- 
pra;  Same  v.  Prince,  supra;  Terre  Haute,  etc.,  R.  R.  Co.  v.  Stock- 
well,  118  Ind.,  98. 

Pi^esentation  ay^d  Retention  of  Doctor's  Bill  Raises  No 
Presumption  of  Liability. — The  presentation  of  a  bill  to  a 
person  containing  charges  against  him  for  services  rendered 
another  person,  and  his  retention  of  that  bill  without  disclaimer 
of  liability,  does  not  raise  a  presumption  of  liability,  for  it  is 
not  necessarily  an  account  stated.  To  constitute  an  account 
stated,  there  must  be  not  only  a  statement  of  account,  but  ac- 
quiescence in  it ;  mere  retention  of  the  account  is  not  sufficient. 

Bills  Presented  Not  Conclusive  as  to  Amounts  Charged. 
— On  the  other  hand,  if  a  bill  is  presented  v^hich  contains 
charges  which  are  not  acquiesced  in,  the  person  making  out 
and  presenting  the  bill  is  not  absolutely  bound  by  the  charges 
therein  contained,  although  such  a  bill  affords  some  evidence 
as  to  the  value  of  the  services  rendered.' 

Claims  Against  Estates  of  Deceased  Persons. — A  bill  for 
a  physician's  services  constitutes  a  claim  against  the  estate  of 

'  Bronson  v.  Hoffman,  7  Hun,  of  Med.,"  svpra,  p.  46;  but  see 
674  ;  Williams  v.  Glenny,  16  N.  Y. .  also  Danzinger  v.  Hoyt,  46  Hun, 
389,  and  see  Ordronaux  on  "  Juris.      270. 


44  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

a  deceased  person,  like  any  other  debt.  In  some  States  it  is  a 
preferred  claim.'  In  this  connection  it  should  be  observed  that 
short  statutes  of  limitation  exist  in  most  countries  and  States 
applicable  to  such  cases,  shorter  than  the  ordinary  limitation 
imposed  by  law  upon  the  right  to  sue  upon  claims  for  services 
rendered  (which  is  six  years).  In  order  to  preserve  his  legal 
rights,  the  physician  should  as  soon  as  possible  after  the  death 
of  the  person  for  whom  his  services  have  been  rendered,  as- 
certain who  is  the  administrator  or  executor  of  the  estate  of 
such  person,  and  file  with  such  representative,  personally,  proof 
of  his  claim. 

Patient  who  Receives  Benefit  of  Services  of  Consulting 
Physician  Liable. — The  liability  of  a  patient  for  the  services 
of  a  consulting  physician  is  generally  governed  by  the  same 
rules  as  his  liability  to  the  ph3'sician  in  immediate  charge  of 
the  case.* 

Where  the  patient  accepts  the  services  of  a  consulting  phy- 
sician, although  he  has  not  directly  requested  them,  he  must 
pay  for  them  if  he  receives  the  benefit  of  them  without  object- 
ing, because  it  will  be  presumed  that  he  ratified  the  act  of  the 
physician  who  was  in  charge  of  the  case,  in  calling  the  other 
physician  into  consultation.^ 

But,  however  this  may  be,  it  is  a  principle  of  professional 
ethics,  which  has  almost  acquired  the  authority  of  legal  doc- 
trine, that  a  physician  in  charge  of  a  case  should  obtain  the  fuU 
assent  of  a  patient,  or  of  his  family  and  friends,  if  he  is  too  ill 
to  give  his  own  consent,  to  the  calling  of  another  ph3'sician  in 
consultation. 

No  Other  Stranger  can  he  Called  into  Sick-Boom  ivithout 
Assent  of  Patient. — A  limitation  upon  the  authority  and  right 
of  an  attending  physician  is,  that  if  he  desires  or  attempts  to 
call  in  a  stranger  not  a  physician,  he  must  obtain  his  patient's 

'  And  it  has  been  held  that  a  de-  -  Grain  v.  Baudouin,  supra;  Shel- 
cedent's  estate  is  liable  for  fees  of  ton  v.  Johnson,  40  Iowa,  84 ;  Garry- 
expert,  who  by  direction  of  probate  v.  Stadlen,  67  Wis. ,  512. 
court  examined  widow  and  testified  ^  And  a  physician  may  recover  the 
as  to  her  pregnancy.  This  notice  value  of  services  rendered  by  his 
was  put  upon  the  ground  that  his  students.  People  v.  Monroe,  4 
testimony  was  necessary  for  the  in-  Wend.  (N.  Y. ) ,  200  ;  Jay  Co.  v. 
formation  of  the  court  in  a  matter  Brewington,  74  Ind. ,  7.  And  the 
before  it  affecting  the  disposition  of  physician  in  attendance  is  not  lia- 
the  estate.  Eollwager  v.  Powell,  bie  to  the  physician  thus  called. 
S  Hun,  10.  Guerard-e.  Jenkins,  IStrobh.,  171. 


CONSULTATIONS.  45 

consent.  The  obligation  of  a  physician  toward  his  patient  of 
secrecj^  and  confidence  is  regarded  as  very  strict,  and  if  a  phy- 
sician should  call  in  a  student  or  other  stranger,  without  first 
consulting  his  patient,  or  those  who  are  in  some  measure  related 
to  him  and  connected  with  him,  it  would  be  a  verj"  severe 
stretch  of  morals  and  possibly  of  law.  In  fact,  in  a  recent  case 
in  Michigan,  a  physician  was  held  liable  for  damages  who 
called  in  a  stranger,  an  unmarried  man,  who  was  an  unprofes- 
sional man,  to  be  with  him  while  he  was  in  attendance  on  a 
confinement  case.  In  that  case  both  the  physician  and  the 
person  so  called  in,  and  who  was  present  at  that  time,  were 
held  liable  in  damages ;  and  it  was  further  held  that  the  right 
to  recover  was  not  affected  by  the  fact  that  the  patient  supposed 
that  the  person  so  called  in  was  a  medical  man,  and  therefore 
submitted  to  his  presence  without  objection.* 

The  statutes  which  create  the  privilege  as  to  professional 
communications  and  information  necessary  to  enable  the  phy- 
sician to  prescribe,  might  not  apply  to  students  or  other 
strangers,  and  this  is  probably  the  reason  for  the  rule  of  law 
laid  down  in  the  Michigan  case.  The  obligation  to  preserve 
inviolate  a  communication  as  a  privileged  communication,  in- 
cluding in  the  meaning  of  the  word  "  communication"  all 
knowledge  or  information  received  while  in  attendance  upon  a 
case,  would  be  held  to  have  been  broken  by  the  act  of  the  phy- 
sician in  bringing  in  a  stranger  who  would  not  be  privileged 
from  testifying. 

Measure  of  Recovery  for  Services  Rendered. 

Terms  of  Express  Contract  Govern — Reasonable  Worth 
the  Rule  in  Implied  Contracts. — In  case  of  an  express  con- 
tract its  terms  necessarily  measure  the  amount  of  the  charges. 
In  the  absence  of  an  express  contract  fixing  the  value  of  the 
services  to  be  rendered,  the  measure  of  damages  for  breach  of 
payment  is  like  that  in  any  other  case  of  personal  services,  the 
reasonable  worth  and  value  of  the  services  performed.  So  like- 
wise if  medicines  or  appliances  are  furnished,  which  are  not 
reasonably  to  be  expected  and  furnished,  according  to  the  cus- 
tom of  the  school  to  which  the  physician  or  surgeon  belongs,, 
'  Deway  v.  Eoberts,  46  Michigan,  160. 


46  LEGAL   STATUS   OF   PHYSICIANS^BECKER. 

the  reasonable  worth  and  value  at  the  time  of  furnishing  them, 
and  at  the  place  of  furnishing  them,  is  the  measure  fixed  by 
the  law  to  determine  what  shall  be  recovered  for  them.' 

Value — Hoiu  Proved. — When  the  medical  man  is  com- 
pelled to  go  into  court  to  enforce  payment  for  his  services,  it 
has  been  questioned  whether  he  can  testify  to  the  services  ren- 
dered, and  the  facts  and  circumstances  surrounding  the  patient 
at  the  time  of  the  treatment,  because  it  has  been  claimed  that 
he  could  not  do  so  without  violating  the  statute  against  the 
disclosure  b}^  physicians  of  information  received  which  is  nec- 
essary to  enable  them  to  prescribe.  The  tendency  of  the  later 
decisions,  however,  seems  to  be  that  the  breach  of  the  patient's 
contract  to  pay  relieves  the  physician  from  his  obligation  of 
secrecy,  and  consequentlj^,  that  if  it  is  necessary  for  him  to  go 
into  court  and  prove  the  value  of  his  services,  he  may  testify, 
within  reasonable  limitations,  to  all  matters  necessary  to  inform 
the  court  fully  as  to  the  nature  and  extent  of  the  disease  or 
injuries  of  the  patient,  in  order  that  he  may  show  the  responsi- 
bility imposed  upon  him  and  the  extent  of  the  services  that 
he  has  rendered.  This  subject  will  be  fully  considered  under 
the  head  of  "  Privileged  Communications. "  The  usual  course  of 
practice  where  there  is  not  an  express  contract  fixing  the 
charges,  is  to  prove  the  facts  and  circumstances  showing  the 
treatment  and  services,  and  then  to  produce  other  physicians 
who,  in  answer  to  a  hypothetical  question  stating  the  facts  and 
circumstances  in  the  case,  assuming  them  as  true,  are  allowed, 
if  they  state  they  know  the  value  of  such  services,  to  give  an 
expert  opinion  as  to  what  that  value  is.^  It  has  also  been  said 
(Ordronaux,  "  Jurisprudence  of  Medicine,"  §  43),  that  if  a  fee- 
bill  of  charges  for  such  services  has  been  established  by  an 
association  of  physicians  recognized  hj  law,  such  as  a  countj^ 
medical  society  or  a  State  medical  society,  incorporated  pursu- 
ant to  statute,  such  fee-bill  can,  if  properly  authenticated  as 
having  been  adopted  by  the  association,  be  offered  in  evi- 
dence on  behalf  of  the  patient  and  against  the  physician.  But 
such  a  fee-bill  in  such  a  case  would  not  be  held  to  be  conclusive 


'  MacPherson'».Chedell,24Wend.,  presumed  to  be   experts  as  to  the 

15;  Adams  v.   Stevens,    26  Wend.,  value  of  other  physicians' services. 

451 ;  Story  on  Bailments,  §  37.  Beekman    v.    Platner,     15     Barb. , 

*  Duly     licensed    physicians    are  550. 


GENERAL   ADVICE.  47 

evidence  of  the  value  of  the  services,  but  will  be  received  in 
evidence,  if  at  all,  merely  for  the  purpose  of  showing  what  was 
the" usual  and  ordinary  charge  in  such  cases.  As  we  shall  see 
later  on,  under  "Malpractice,"  a  judgment  for  services  ren- 
dered, however  small,  is  a  bar  to  an  action  of  malpractice,  be- 
cause a  judgment  for  the  value  of  the  services  rendered  involves 
proof  on  the  part  of  the  plaintiff,  and  a  finding  on  the  part  of 
the  court,  that  the  services  had  value  and  were  skilfully  per- 
formed and  properly  rendered.' 

Custom  of  Physicians  to  Treat  Each  Other  Gratis,  En- 
forceable.— Physicians  frequently  treat  each  other,  and  it  has 
been,  held,  where  the  custom  exists  to  do  so  without  charge, 
that  such  a  custom  is  binding.  Of  course,  this  rule  does  not 
prevent  phj^sicians  from  making  an  express  contract  to  waive 
the  custom  and  agreeing  that  the  services  be  compensated. 

Elements  to  he  Proved  in  an  Action  for  Service,  etc. — 
General  Advice. — The  result  of  these  rules  may  be  thus  sum- 
marized, viz. :  The  elements  to  be  established  in  an  action  for 
services  by  a  physician  against  a  patient  are  three  in  number — 
(1)  the  employment;  (2)  the  performance  of  the  services;"  and 

1  Bellinger  v.  Craigue,  31  Barb. ,  him.  On  the  other  hand,  in  an 
534;  Gates  iJ.  Preston,  41  N.  Y.,  113;  action  for  malpractice  brought  l)y 
Blair  v.  Bartlett,  75  N.  Y. ,  15.  the  patient  against  a  physician. 
The  general  rule  is  that  in  an  action  which  is  generally  in  form  an  action 
arising  on  contract  damages  arising  for  a  tortious  act,  or  neglect,  the 
for  a  tort  cannot  be  set  up  as  a  physician  cannot  plead  the  perform - 
counter-claim.  It  follows  from  this  ance  of  services  and  the  non-pay - 
that  in  an  action  of  a  physician  for  ment  of  his  bill  as  a  counter-claim 
services,  damages  for  malpractice  or  recoupment,  because  that  arises 
could  not  be  recouped  or  counter-  on  a  contract.  If  there  is  any  ex- 
claimed ordinarily.  The  way  in  ception  to  this  rule  it  will  be  found 
which  that  rule  is  avoided,  and  to  grow  out  of  the  language  of  see- 
the safer  method,  is  for  the  defend-  tions  549  and  550  of  the  Code  of 
ant  to  plead  that  it  was  part  of  the  Civil  Procedure  of  the  State  of 
contract  of  the  physician  (which  it  New  York,  and  of  similar  enact- 
undoubtedly  is),  to  perform  his  ser-  ments  in  other  States,  which  permit 
vices  in  a  faithful  and  skilful  man-  counter-claims  arising  out  of  the 
ner,  and  that  he  committed  a  breach  same  subject-matter  as  the  cause  of 
of  it,  thus  charging  the  damages  action,  to  be  pleaded  in  that  action, 
which  flowed  from  his  acts  as  a  In  New  York  State,  however,  any 
breach  of  contract,  not  as  a  cause  of  effect  of  that  kind  is  negatived  by 
action  in  tort  for  malpractice  or  neg-  the  general  provision  that  the  ac- 
ligence.  If  that  is  done  the  counter-  tions  must  not  only  arise  out  of  tlie 
claim  arising  in  malpractice  can  same  subject-matter  but  be  of  the 
probably  be  pleaded  in  an  action  for  same  kind  and  class, 
services,  and  possibly  a  counter-  '■  The  degree  of  care  and  skill  re- 
claim in  excess  of  the  amount  quired  to  be  shown  to  entitle  tlie 
claimed  by  the  physician  recovered  physician  or  surgeon  to  recover 
as  an  affirmative  judgment  against  compensation    for  his  services  has 


48  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

(3)  the  value  of  the  services,  that  value  being  either  a  fixed 
value  determined  by  the  terms  of  the  contract  between  the  par- 
ties, or  the  reasonable  worth  and  value  of  the  services  deter- 
mined by  evidence  of  experts  upon  that  subject.  It  is,  there- 
fore, important  that  physicians  and  surgeons  should  be  advised, 
when  entering  upon  the  practice  of  their  profession,  to  keep  a 
record  of  their  transactions  and  of  their  business  generally. 
Because,  if  they  are  compelled  to  go  into  court  to  recover  for 
their  services,  they  will  be  called  upon  to  describe  with  minute- 
ness the  character  and  extent  of  the  services  they  have  per- 
formed in  order  that  the  value  thereof  may  be  correctly  ascer- 
tained and  determined  in  the  suit.  Any  person  in  active 
practice  who  is  not  blessed  with  a  most  tenacious  and  particular 
memory  is  liable  to  forget  a  great  many  details  which,  with  a 
record  in  hand,  properly  kept,  could  be  brought  to  his  memory 
and  be  testified  to  with  absolute  truthfulness  and  conviction. 
And  the  record  itself,  when  properly  shown  to  be  a  book  of 
original  entry,  is  generally  receivable  in  evidence,  as  a  memo- 
randum of  the  transaction.' 

already  been  stated    to  be  simply  '  Foster -y.  Coleman,  1  E.D.Smith, 

such  care  and  skill  as  are  possessed  85  ;  Larue  v.  Rowland,  7  Barb. ,  107  ; 

by  the  majority  of  other  professional  Clarke  v.  Smith,  46  Barb. ,  30  ;  Kniglit 

men  of  the  same  school  of  practice  v.  Cunningham,  6  Hun,  100 ;  Bay  v. 

at  the  time,  or  what  is  known  as  Cook,  23  N.  J.  L. ,  343. 
ordinary  care  and  skill. 


CHAPTER  Y. 

OF  THE  PRIVILEGES  AND  DUTIES  OF  PHYSICIANS  AND 
SURGEONS  WHEN  SUMMONED  AS  EXPERT  WITNESSES 
IN   COURTS   OF   JUSTICE.! 

Introductory — Distinction  Between  Expert  Witnesses 
and  Other  Witnesses. — One  of  the  most  important  positions  that 
a  medical  man  is  called  upon  to  assume  by  virtue  of  his  profes- 
sional character,  is  the  position  of  expert  witness.  Most  writers 
on  medical  jurisprudence  confine  themselves,  in  the  discussion 
of  this  subject,  to  presenting  the  medico-legal  rules  which  ap- 
pertain to  this  position,  and  concede  its  high  importance. 
Before  defining  what  is  meant  b}'  the  term  expert  witness,  or 
treating  of  the  rules  which  determine  the  status  of  such  wit- 
nesses in  court,  and  their  duties,  it  seems  advisable  to  introduce 
the  subject  by  a  brief  consideration  of  the  distinction  between 
ordinary  witnesses  and  expert  witnesses.  When  medicine  and 
law  are  united  in  the  purpose  of  investigating  facts,  and  bring- 
ing about  a  legal  determination  as  to  what  are  or  are  not  facts, 
they  co-operate  with  each  other  in  this  way.  The  law  furnishes 
the  machinery  for  the  inquiry  and  the  rules  which  determine 
how  it  shall  be  prosecuted.  The  medical  man,  however,  is 
called  upon  as  an  assistant  to  the  law,  because  of  his  skill  and 
experience  in  his  profession,  which  enable  him  to  ascertain  and 
interpret  the  circumstances  from  which  the  facts  sought  to  be 
established  are  to  be  inferred.  Ordinary  witnesses  testify  con- 
cerning matters  of  observation,  the  court  and  jury  being  en- 
dowed with  the  sole  power  to  determine  the  credibility  of  their 
evidence  and  the  true  result  of  their  observations.  Yet  the 
border  line  of  distinction  between  witnesses  who  testify  merely 
to   actual  matters  of  observation,   and  those  who   give  their 

■  The  writer  is  indebted  for  many      admirable  lectures  on  Medical  Ju- 
valuable     suggestions     concerning      risprudence  before  the  Medical  De- 
this  svibject  to  Ansley  Wilcox,  Esq. ,      partment  of  the  Universitj'  of  Buf- 
of  the  Buffalo,  N.  Y. ,  Bar,  and  his      falo. 
4  49 


50  LEGAL   STATUS   OF  PHYSICIANS — BECKER. 

opinions  upon  and  draw  inferences  from  established  facts  and 
circumstances,  is  a  wavering  one.  The  general  rule  of  evidence 
is  well  understood,  that  hearsay  evidence  is  inadmissible,  and 
yet,  like  any  other  rule,  this  has  its  exceptions  which  grow  out 
of  the  necessities  of  given  cases.  This  is  so  because  there  are 
and  always  will  be,  matters  brought  before  courts  for  investi- 
gation and  determination,  long  after  the  witnesses  who  person- 
ally saw  the  facts  and  circumstances  of  the  particular  case  in 
which  such  matters  are  concerned  have  died,  or  have  with- 
drawn beyond  the  reach  of  the  process  of  the  court.  Possibly 
no  record  in  writing  of  such  facts  and  circumstances  has  been 
left,  or  if  in  writing  it  lacks  the  sanctity  of  being  a  judicial 
writing,  and  hence  is  no  better  evidence  than  any  other  form 
of  hearsay  evidence.  For  this  reason  in  matters  of  family 
history,  pedigree,  custom,  and  the  like,  hearsay  evidence  is 
permitted,  and  is  entitled  to  as  much  weight  as  any  other  evi- 
dence, if  the  witnesses  giving  it  be  trustworthy. 

In  Matters  of  Common  Experience  Witnesses  in  General 
Often  State  Conclusions. — Moreover,  in  matters  of  common 
experience,  the  testimony  of  any  witness,  if  carefully  analyzed, 
often  shows  that  he  is  sometimes  allowed  to  draw,  and  state, 
his  conclusions  and  inferences,  instead  of  being  required  to 
confine  his  evidence  simpty  to  telling  in  the  strictest  possible 
way,  and  with  the  closest  limitations,  what  he  actually  wit- 
nessed. A  good  illustration  of  this  is  the  case  of  a  person  who 
sees  a  crime  of  homicide  committed  by  shooting,  and  is  called 
upon  to  testify  in  court.  He  would  be  allowed  to  testify  that 
the  defendant,  if  he  could  identify  the  prisoner  at  the  bar  as 
such,  was  the  person  whom  he  saw  fire  the  shot,  although  he 
might  not  have  examined  him  with  close  scrutiny,  and  might 
never  have  seen  him  before  the  crime.  In  saying  that  the  de- 
fendant was  the  person  who  fired  the  shot,  while  he  would  be 
in  terms  testifying  to  a  fact,  he  would  still  be  drawing  an 
inference,  and  giving  an  opinion,  based  upon  his  recollection 
of  the  person  whom  he  saw  engaged  in  the  act  of  firing,  and  of 
the  likeness  or  resemblance  of  such  person  to  the  prisoner  at 
the  bar,  which  would  be  a  matter  of  comparison  and  of  opinion. 
So,  too,  although  he  could  not  see  the  bullet  take  its  course 
from  the  mouth  of  the  gun  and  imbed  itself  in  the  body  of  the 
deceased,  yet  if  he  saw  the  firing,  heard  the  explosion,  saw  the 


WITNESSES   IN  GENERAL   OFTEN   STATE   CONCLUSIONS.        51 

flash  and  smoke  of  the  powder,  observed  the  direction  in  which 
the  accused  pointed  the  weapon,  and  saw  the  deceased  stagger 
and  fall,  he  would  be  allowed  to  testify  in  answer  to  a  direct 
question  whether  or  not  the  accused  shot  the  deceased.  And, 
yet  in  making  up  that  answer  he  would  be  testifying  not 
simply  to  a  matter  of  actual  observation,  but  to  a  conclusion. 
As  it  is  in  reference  to  the  question  of  identity  so  it  is  as  to 
many  other  matters  which  come  before  our  courts,  in  all  of 
which  the  witnesses  are  permitted,  without  objection,  to  testify 
to  conclusions  and  to  give  answers  which  are  the  result  of  in- 
ferences which  they  draw  themselves,  rather  than  a  statement 
of  their  actual  observations.  The  law  is  not  a  metaphysical 
but  a  practical  science,  limited  and  confined  b}^  the  practical 
restrictions  which  experience  has  shown  must  be  put  upon  it, 
in  order  to  enable  it  to  accomplish  its  object  of  administering 
justice  between  man  and  man.  Men  form  such  conclusions  as 
have  been  indicated,  instinctively  and  unconsciouslj",  and  it 
would  be  practicably  impossible  for  them  to  narrate  an}-  occur- 
rence without  embodying  in  their  narration  some  of  these  nat- 
ural and  unconscious  conclusions.  The  law,  therefore,  includes 
among  the  matters  which  witnesses  are  permitted  to  charac- 
terize as  facts,  those  daily  and  hourly  inferences  and  deductions 
which  all  men  are  accustomed  to  make,  and  concerning  which 
no  two  men  who  are  properly  constituted  can  greatly  differ. 
It  is  true  that  this  practice  sometimes  leads  to  error,  but  it  has 
grown  out  of  necessity.  The  greatest  safeguard  is,  that  upon 
the  trial  of  a  question  of  fact  both  sides  are  represented  by 
counsel,  and  the  opportunity  which  cross-examination  offers  to 
an  advocate  of  even  reasonable  and  ordinary  skill  is  such,  that 
these  conclusions  and  inferences  may  be  sifted  down  through 
the  chain  of  observation,  and  the  process  of  drawing  these  con- 
clusions and  inferences  from  a  series  of  facts,  tested  in  such  a 
manner  that  the  improbability,  probability,  or  truth  of  any  given 
inference  or  conclusion  may  be  determined  with  substantial 
accuracy.  The  illustrations  which  have  been  given  above 
exhibit  the  simplest  form  in  which  so-called  direct  testimony 
can  be  demonstrated  to  be  not  always  positive  and  direct  testi- 
mony, but  somewhat  a  matter  of  inference.  Other  examples 
and  illustrations  of  common  occurrence  will  exhibit  still  more 
closely  the  line  between  actuality  and  opinion.     At  times  it 


52  LEGAL  STATUS   OF   PHYSICIANS — BECKER. 

becomes  essential  to  the  determination  of  a  question,  that  the 
courts  should  know  whether  or  not  a  person  was  angry,  whether 
or  not  he  was  intoxicated,  or  whether  or  not  at  a  given  time, 
when  his  mental  status  was  under  observation,  he  acted  ration- 
ally or  irrationall3^  Lay  witnesses  have  for  many  years  been 
permitted  to  testify  from  observation,  and  without  possessing 
any  special  qualification  to  do  so,  as  to  the  existence  or  non- 
existence of  such  conditions  as  those  just  mentioned  in  a  person 
whose  actions  are  under  consideration.  It  is  manifest  that  in 
making  any  such  inferences  the  witnesses'  testimony  is  mainly 
a  conclusion  based  on  inference.  Take  the  case  of  anger.  How 
shall  that  be  determined?  It  is  difficult  to  describe  anger.  A 
loud  voice,  a  flushed  face,  the  use  of  bitter  words,  nervous, 
excitable,  demonstrative  action — all  these  symptoms  might 
occur,  or  but  few  of  them  might  occur.  So,  too,  in  the  matter 
of  intoxication.  It  is  well  known  that  some  individuals  exhibit 
the  effects  of  intoxicants  in  an  entirely  different  manner  and 
degree  from  others.  Some  men  who  are  verj'  much  intoxi- 
cated, so  as  to  be  quite  incapable,  in  the  eye  of  the  law,  of 
forming  a  criminal  intent,  or  of  contracting  an  obligation 
which  would  be  valid,  may  still  be  able  to  walk  perfectly 
straight,  or  to  talk  without  much  confusion.  Others,  whose 
walk  and  demeanor  would  indicate  a  considerable  degree  of 
intoxication,  might  be  mentallj^  clear  and  unruffled  and  even 
stimulated  by  intoxicants  to  precise  mental  co-ordination  and 
reasoning.  Again,  there  are  persons,  as  to  whom  a  witness, 
after  stating  that  he  had  observed  them,  and  after  stating  the 
particular  matters  and  things  in  which  such  persons  were 
engaged,  might  with  apparent  accuracy  state  that  they  acted 
rationally  or  irrationally,  and  yet  such  persons  might  neverthe- 
less, upon  furthfr  examination,  be  found  to  have  been  acting 
according  to  a  particular  custom  or  habit,  or  idiosyncrasy'  of 
long  years'  standing.  Thus  it  is  apparent  that  in  each  of  these 
cases,  when  the  witness  attempts  to  state  what,  out  of  neces- 
sity, the  court  treats  as  a  fact — viz. ,  whether  a  given  person  is 
or  is  not  angrj^,  or  intoxicated,  or  irrational — the  witness  is 
really  testifying  to  the  result,  in  his  own  mind,  of  his  observa- 
tions of  the  condition  and  conduct  of  the  person  who  is  under 
investigation,  when  compared  with  a  standard  which  the  wit- 
ness has  erected  for  himself.     Hence  such  results  are  really 


WITNESSES   PERMITTED    TO   DRAW   CONCLUSIONS.  53 

matters  of  opinion  evidence,  pure  and  simple.  Other  examples 
of  a  like  character  are  found  in  statements  as  to  weight, 
height,  distance,  speed,  and  the  like,  as  to  which  men  of  com- 
mon powers  of  observation,  who  are  not  strictly  experts,  are, 
because  of  convenience  and  necessit}''  and  the  probability  of 
reasonable  and  ordinary  accuracy,  commonly  permitted  to  give 
their  own  judgment  and  conclusions  as  evidence. 

All  Witnesses  Often  Permitted  to  Draw  and  State  Con- 
clusions in  Matters  Involving  Numerous  and  Complicated 
Details. — Thus  the  practical  necessity  of  the  administration 
of  justice  has  led  to  the  establishment  of  tlie  rule,  that  where 
the  details  of  an  occurrence  are  numerous  and  complicated,  and 
are  incapable  of  precise  description  by  ordinary  observers,  wit- 
nesses are  permitted  to  use,  in  testifying,  general  expressions 
which  really  embody  their  conclusions  from  the  facts  or  details 
observed  by  them.  Greenleaf  on  Evidence,  Section  440,  note 
A;  Wharton  on  Evidence,  Section  434. 

Wharton  says  that  "the  distinction  between  expert  wit- 
nesses and  ordinary  witnesses  is  this :  the  non-expert  witness 
testifies  to  conclusions  which  may  be  verified  by  the  adjudicat- 
ing tribunal;  the  expert,  to  conclusions  which  cannot  be  so 
verified.  The  non-expert  gives  the  results  of  a  process  of  rea- 
soning familiar  to  every-day  life ;  the  expert  gives  the  results 
of  a  process  of  reasoning  which  can  be  determined  only  by  spe- 
cial scientists."  See  also  People  v.  Fernandez,  35  N.  Y.,  49. 
People  V.  Deacons,  109  N.  Y.,  374-382. 

This  learned  writer  (Wharton)  also  says,  at  Section  437  of 
the  same  treatise : 

"  Where  conclusions  depend  upon  facts  whose  evidential 
weight  can  only  be  determined  by  those  familiar  with  a  partic- 
ular specialty,  then  these  conclusions  may  be  given  by  experts 
in  such  specialty."  Such  also  is  the  exact  derivative  meaning 
of  the  word  expert,  it  being  derived  from  the  Latin  word 
" expertus,"  meaning,  literally,  "experienced,"  and  hence 
skilled  by  experience. 

Functions  of  an  Expert  Witness  Essentially  Judicial. — 
It  is  the  function  of  an  expert  witness  to  reason  about  facts,  to 
explain  their  connection  with  one  another,  and  to  draw  conclu- 
sions and  inferences  from  them.  Hence,  a  witness,  however 
expert  in  any  ordinary  sense  in  his  specialt}^  when  ho  is  called 


54  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

upon  merely  to  narrate  facts  which  he  has  observed,  is  an  ordi- 
nary witness,  and  is  governed  by  the  same  rules  which  apply  to 
the  ordinary  witnesses.  When,  however,  he  is  called  upon,  in 
addition  to  recounting  facts,  to  explain  or  interpret  them  by 
reference  to  assumed  facts,  he  becomes  properly  an  expert 
witness.  It  thus  appears  that  an  expert  witness  must  neces- 
sarily perform  a  part  of  the  duties  which  devolve  upon  the 
court  or  the  jury.  His  position  is,  therefore,  essentially  judi- 
cial, except  that  he  has  no  power  to  enforce  his  determinations 
by  judicial  process.  The  importance  and  responsibility  which 
the  law  thus  confers  upon  an  expert  are  of  the  highest  character. 
He  ranks  the  coequal  with  the  tribunal  itself  in  his  peculiar 
province,  so  far  as  relates  to  his  individual  responsibility.  That 
this  should  tend  to  elevate  such  witnesses  to  a  high  social  posi- 
tion, and  ought  to  require  the  most  exact  and  faithful  integrity 
of  purpose  and  statement,  is  self-evident. 

Difference  Between  Status  of  Expert  Witnesses  in  France 
and  Germany  and  in  the  United  States  and  England. — In 
some  foreign  countries,  notably  in  Germany  and  in  France, 
experts  in  medico-legal  matters  have  an  assured  official  posi- 
tion, and  are  generally  not  allowed  to  be  selected  at  hap-hazard 
according  to  the  will  or  the  length  of  the  purse  of  those  who 
need  their  services.  The  consequence  of  this  method  of  obtain- 
ing expert  evidence  is,  that  expert  witnesses  in  those  countries 
command  a  high  measure  of  respect  and  honor. 

Unfortunately,  however,  in  this  country,  where  the  opposite 
practice  prevails,  the  weaknesses  of  human  nature  are  such 
that  the  common  people,  newspapers,  lawyers,  and  even  the 
courts  in  some  recorded  opinions  and  decisions,  have  come  to 
express  a  great  want  of  confidence  in  the  weight  and  value  of 
expert  testimony.  This  deplorable  result  of  a  bad  system  of 
procedure  is  universally  recognized,  yet  our  State  legislatures 
have  as  j'et  refrained  from  attempting  to  correct  it. 

Hence,  in  considering  the  value  of  expert  testimony  in  mat- 
ters of  medical  jurisprudence,  it  must  be  conceded,  in  the  first 
instance,  that  the  difference  between  the  system  prevailing  in 
this  country  and  in  England,  and  that  which  prevails  on  the 
Continent,  notably  in  Germany  and  France,  has  not  tended  to 
raise  but  to  depress  the  value  of  such  testimony  in  the  first- 
named  countries.      In  the  latter   countries,   the   experts   upon 


STATUS   OF   WITNESSES   IN   DIFFERENT   COUNTRIES.  55 

medico-legal  questions  are  officers  of  the  court,  or  are  treated 
as  such.  They  form,  in  a  sense,  a  part  of  the  judicial  system, 
and  the  expression  of  their  opinions  consequently  carries  with 
it  great  weight.  Moreover,  under  the  system  which  prevails 
there,  it  has  been  possible  for  men  to  be  educated  up  to  a  high 
degree  of  skill  and  experience  in  the  particular  branches  of 
physiological  or  psychological  or  physical  investigations  which 
they  pursue,  while  here  in  America,  and  to  a  certain  extent  also 
in  England,  experts  are  such  for  other  reasons,  and  by  the 
operations  of  other  causes,  than  the  fact  of  their  permanent 
employment  in  that  capacity.  As  a  general  thing  they  become 
skilled  in  their  profession  or  in  the  particular  branches  of  it 
in  which  they  practise  as  specialists,  and  are  summoned  to 
testify  simply  because  they  are  selected  by  one  party  or  another 
to  a  lawsuit. 

31r.  Wha7'to7fs  View  of  this  Question  in  the  Mairi  Hostile 
to  the  Prevailing  System  Here. — The  effect  of  the  methods 
which  thus  prevail  has  not  been  entirely  to  the  advantage  of  the 
miedical  profession  or  of  our  courts.  Wharton,  in  his  work  on 
"Evidence,"  Section  454,  observes  upon  this  point:  "When 
expert  testimony  was  first  introduced  it  was  regarded  with 
great  respect.  An  expert  was  viewed  as  the  representative  of  a 
science  of  which  he  was  a  professor,  giving  impartially  its  con- 
clusions. Two  conditions  have  combined  to  produce  a  material 
change  in  this  relation.  In  the  first  place  it  has  been  discov- 
ered that  no  expert,  no  matter  how  learned  and  incorrupt, 
speaks  for  his  science  as  a  whole.  Few  specialties  are  so  small 
as  not  to  be  torn  by  factions,  and  often  the  smaller  the  specialty 
the  bitterer  and  more  inflaming  and  distorting  are  the  animos- 
ities by  which  these  factions  are  possessed.  Particularly  is 
this  the  case  in  matters  psychological,  in  which  there  is  no 
hypothesis  so  monstrous  that  an  expert  cannot  be  found  to  swear 
to  it  on  the  stand,  and  to  defend  it  with  vehemence.  ^XiJiil 
tarn  absurdo,^  which  being  literally  translated  means  that 
there  is  nothing  so  absurd  that  the  philosophers  won't  sa}-  it! 
In  the  second  place,  the  retaining  of  experts  by  a  fee  propor- 
tioned to  the  importance  of  their  testimony  is  now  as  customary 
as  is  the  retaining  of  lawyers.  No  court  would  take  as  testi- 
mony the  sworn  statement  of  the  law  given  by  counsel  retained 
on  a  particular  side,  for  the  reason  that  the  most  high-minded 


56  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

men  are  so  swayed  by  an  employment  of  this  kind  as  to  lose 
the  power  of  impartial  judgment;  and  so  intense  is  this  convic- 
tion that  in  every  civilized  communit}^  the  retention  by  a  judge 
of  presents  from  suitors  visits  him  not  only  M^ith  disqualifica- 
tion but  disgrace.  Hence  it  is  that,  apart  from  the  partisan 
character  of  their  opinions,  their  utterances,  now  that  they  have 
as  a  class  become  the  retained  agents  of  the  parties,  have  lost 
all  judicial  authority  and  are  entitled  only  to  the  weight  which 
sound  and  consistent  criticism  will  award  to  the  testimony  itself. 
In  making  this  criticism  a  large  allowance  must  be  made  for 
the  bias  necessarily  belonging  to  men  retained  to  advocate  a 
cause,  who  speak  not  as  to  fact  but  as  to  opinion,  and  who  are 
selected,  on  all  moot  questions,  either  from  their  prior  advocacy 
of  them  or  from  their  readiness  to  adopt  the  opinion  to  be 
proved.  In  this  sense  we  may  adopt  the  strong  language  of 
Lord  Kenyon,  that  skilled  witnesses  come  with  such  a  bias  on 
their  minds  to  support  the  cause  in  which  they  are  embarked, 
that  hardly  any  W' eight  should  be  given  to  their  evidence." 

This  author  then  proceeds  to  show  that  under  the  civil  law 
system  the  conclusions  of  experts  were  formerly  treated  as  un- 
assailable facts,  but  under  the  English  and  American  common 
law  system  this  is  not  the  case,  but  their  testimony  is  to  be 
weighed  by  the  court.  He  says :  "  The  grounds  on  which  the 
conclusion  is  reached  may  be  asked  for :  the  expert's  capacity 
for  drawing  conclusions,  as  well  as  his  premises,  may  be  as- 
sailed. Cases  of  conflict  are  to  be  determined,  not  by  the  nvim- 
ber  of  witnesses,  but  by  the  weight  of  their  testimony,  and 
though  the  opinion  of  an  expert  of  high  character  may  be 
entitled  to  great  respect,  yet  if  questioned,  its  authorit}^  must 
ultimately  rest  upon  the  truth,  material  and  formal,  of  the 
reasoning  on  which  it  depends." 

Judge  Davis,  of  the  Supreme  Court  of  Maine,  in  Neil's 
case  (cited  in  AVharton  and  Stille's  "  Medical  Jurisprudence," 
Vol.  I.,  Section  294),  said:  "If  there  is  any  kind  of  testimony 
that  is  not  only  of  no  value,  but  even  worse  than  that,  it  is  in 
my  judgment  that  of  medical  experts.  They  may  be  able  to 
state  the  diagnosis  of  a  disease  more  learnedly,  but  upon  the 
question  whether  it  had  at  a  given  time  reached  a  stage  that 
the  subject  of  it  was  incapable  of  making  a  contract,  or  irre- 
sponsible for  his  acts,  the  opinions  of  his  neighbors,  of  men  of 


MR.    WHARTON'S   VIEW   OF   THE   QUESTION.  57 

good  common  sense,  would  be  worth  more  than  that  of  all  the 
experts  in  the  country." 

Such  stinging-  criticisms  as  these,  and  others  which  might 
be  cited,  of  a  like  character,  may  not  be  always  merited.  It  is 
certain  that  medical  experts'  opinions,  if  fully  enlightened  by 
scientific  research  and  free  from  partisan  bias,  ought  to  occupy 
a  position  like  that  of  judicial  opinions  in  weight  and  decisive- 
ness upon  the  questions  submitted  to  them.  Such  was  the 
jDOsition  occupied  in  the  public  estimation,  and  in  that  of  judges 
and  counsel,  by  the  great  Dr.  Caspar  in  Germany,  and  Foedere 
or  Pinel,  and  others'"  since  their  time,  in  France.  But  this  posi- 
tion was  acquired  chiefly  because  of  the  fact  already  mentioned, 
that  under  the  system  of  administration  of  justice  which  pre- 
vails in  those  countries  these  great  men  were  regarded,  and 
acted,  as  a  component  part  of  the  judicial  system.  The}-  were 
called  in  as  officers  of  the  law  to  assist  the  court  in  forming  a 
judgment,  and  determining  disputed  questions  of  fact,  in  cases 
involving  life  and  death,  or  the  devolution  of  property,  where 
scientific  experience,  knowledge  and  skill,  not  possessed  by 
judges  or  by  counsel,  was  necessary  for  the  determination  of 
the  questions  involved.  The  root  of  the  evil  in  America  is,  as 
already  pointed  out,  to  be  found  in  the  sj^stem  which  allows 
parties  to  retain  and  pay  their  own  experts  without  anj'  sub- 
stantial restrictions.  Sooner  or  later,  among  the  other  reforms 
in  our  judicial  system,  it  will  be  found  necessary  to  reform  this 
evil  by  the  enactment  of  laws  requiring  that  the  witnesses  in 
medico-legal  cases,  particularly  those  in  which  a  crime  is  alleged 
to  have  been  committed,  shall  be  designated  by  the  court,  or  by 
some  public  authority,  and  paid  from  the  public  treasury  in- 
stead of  by  the  parties.  Such  experts  would  then  occupy  their 
proper  position  of  special  counsel,  advising  and  assisting  the 
legal  counsel  and  the  court,  but  they  would  not  be  taken  out  of 
this  sphere  and  put  in  the  utterly  inconsistent  one  of  witnesses. 
Their  status  and  their  duties  would  be  as  clearly  distinguished 
from  that  of  expert  witnesses  as  now  known,  as  the  status  and 
dat}^  of  the  lawj'er  are  from  the  status  and  duty  of  the  judge. 
The  present  S3'stem  has  been  said  to  be  very  much  like  putting 
a  lawyer,  who  has  just  argued  his  client's  case,  on  the  bench 
to  decide  it.  Whether  experts  should  be  appointed  as  perma- 
nent government  officials,  like  our  judges,  or  should  be  selected 


58  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

specially  for  each  case  like  juries,  referees,  or  arbitrators,  and 
in  the  latter  event  whether  they  should  be  nominated  by  the 
parties  and  selected  by  the  court  from  such  nominees,  or  other- 
wise, are  all  questions  of  detail. 

Our  judges  and  lawyers  seem  slow  to  recognize  the  fact  that 
the  duties  of  experts  are  judicial,  or  at  least  quasi-judicial;  to 
pass  upon  certain  facts  which  neither  the  court  nor  the  jury 
can  understand  without  their  aid.  But,  as  we  have  seen  from 
the  citations  just  given,  judges  and  lawyers  have  fully  recog- 
nized the  unreliability  of  expert  testimony,  produced  as  it  now 
is  in  England  and  in  this  country  at  the  whim  and  selection  of 
the  parties  and  paid  for,  much  or  little,  according  to  the  means 
of  the  parties.' 

Method  of  Preliminary  Examination  of  Experts—  On 
Medical  Questions  a  Licensed  Physician  Presumed  Compe- 
tent.— As  the  system  exists  here,  the  only  power  that  the  court 
nas  over  the  selection  of  an  expert,  is  to  determine,  in  advance 
of  his  testimony  and  of  the  elucidation  of  his  opinions,  whether 
or  not  he  is  competent  as  an  expert.  But  this  power  affords 
little  or  no  check  or  restriction,  because  in  the  effort  to  get  all 
the  light  that  is  possible  upon  the  questions  under  consideration, 
and  to  avoid  unduly  interfering  with  counsel  in  the  conduct  of 
the  case  at  bar,  the  practice  has  become  universal,  and  is  recog- 
nized in  the  decisions  and  text  writers,  of  permitting  any  medi- 
cal  man  who  has  a  license  to  practise  his  profession,  to  testify 
as  an  expert,  and  to  give  his  opinion  as  such  on  any  question 
cognate  to  his  profession.  This  is  so  without  regard  to  the 
amount  of  study  and  experience  he  may  have  had  in  the  par- 
ticular matter  under  consideration.  The  naked  fact  that  he  is 
licensed  to  practise  is  enough.  He  then — that  is,  after  testify- 
ing that  he  is  a  practising  physician — is  clothed  with  the  gar- 
ment of  authority.     The  only  way  in  which  his  knowledge  can 

'  The  conservatism  of  lawj^ers  is  defects  of  the  system  as  it  now  ex- 
proverbial.  It  is  hard  to  convince  ists  has  been  brought  to  public  at- 
them  that  forms  that  have  been  long  tention  in  the  journals  of  the  day, 
in  use  and  have  been  found  to  serve  in  papers  read  before  medical  socie- 
a  useful  purpose  in  the  past,  are  not  ties  and  bar  associations,  and  in 
applicable  to  new  conditions  as  they  ai-guments  in  legislative  bodies,  and 
arise ;  for  instance,  that  the  meth-  it  is  lioped  and  believed  that  ere 
ods  of  procuring  the  attendance  and  long  a  reform,  something  of  tlie 
of  examining  ordinary  witnesses  do  character  indicated,  maj^  be  brought 
not  fit  the  necessities  of  expert  tes-  about  in  this  very  important  mat- 
timony.     But  the  question  as  to  the  ter. 


METHOD    OF   PRELIMINARY   EXAMINATION   OF   EXPERTS.         59 

be  tested  is  by  cross-examination  as  to  his  experience  and  skill, 
and  possibly  by  contrasting  him  as  he  appears  upon  the  witness- 
stand  and  his  history  as  he  gives  it,  with  other  and  more  or  less 
experienced  and  skilful  men  who  follow  him. 

The  rule  is,  that  when  a  witness  is  produced  to  give  an 
opinion  on  a  medical  question,  he  is  interrogated  by  the  coun- 
sel who  produces  him  as  to  his  qualifications.  At  this  point, 
before  he  is  allowed  to  give  his  opinion,  it  is  proper  and  cus- 
tomary that  the  counsel  ui3on  the  other  side  of  the  case  should 
be  allowed  an  opportunity  to  cross-examine  as  to  his  compe- 
tency, and  then  the  court  determines  whether  or  not  he  is  a 
competent  witness.  If  the  court  pronounces  him  competent, 
a  hypothetical  question  is  put  to  him  stating  the  facts  of  the 
case,  as  the  counsel  interrogating  him  claims  them  to  be  estab- 
lished by  the  evidence,  and  the  expert  is  then  asked  to  give  his 
opinion  on  the  question  at  issue,  based  upon  an  assmnption 
that  the  facts  stated  are  truly  stated.  Then  the  opposing  coun- 
sel has  the  right  to  cross-examine,  and  to  ask  his  views  and 
opinions-  upon  the  same  question  at  issue,  but  assuming  as  true 
other  and  different  facts  or  premises,  as  he  claims  them  to  be 
established  by  the  evidence.  This  often  involves  a  test  of  wit 
and  intelligence,  and  of  forensic  acumen,  between  the  •  counsel 
and  the  witness,  which  serves  very  little  useful  purpose,  ex- 
cept perhaps  to  elucidate  more  strongly  than  has  been  here 
stated  the  defects  of  the  system  which  now  obtains.  It  is  also 
not  unusual,  and  in  fact  is  the  result  of  the  workings  of  human 
nature,  that  under  the  manipulations  of  counsel  skilled  in  cross- 
examination,  skilled  in  methods  of  indirection  in  stating  facts, 
and  armed  with  the  powerful  weapon  of  the  rule  which  permits 
them  to  insist  upon  a  categorical  yes-or-no  answer  to  a  question, 
the  jury  and  the  court  become  confused,  the  witness  loses  his 
temper,  or  becomes  affected  more  strongly  than  ever  before  by 
bias  against  his  persecutors,  as  he  feels  them  to  be,  and  the 
examination  ends  in  a  farce.  This  is  not  always  the  case,  and 
the  illustration  given  is  an  extreme  one.  Like  the  citations 
from  judicial  criticism  of  expert  testimony  which  have  been 
given,  these  matters  are  only  adverted  to  here  as  danger  signals, 
a  warning  to  both  professions,  and  with  an  earnest  suggestion 
of  the  necessity  of  reform. 


60  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 


EXPERTS,   HOW  SUMMONED   INTO   COURT. 

They  Must  Obey  the  Summons  and  Appear  and  be  Sworn. 
In  General  they  need  Not  Give  their  Opinions  unless  Duly 
Compensated. — An  expert  witness  is  brought  into  court  like  an 
ordinarj^  witness  by  the  usual  process  of  the  court.  This  pro- 
cess is,  under  the  American  system,  an  ordinary  subpoena,  and, 
being  process  of  the  court,  whether  or  not  he  has  been  paid  or 
promised  compensation  for  giving  his  opinion  he  must  obey 
the  process  to  the  extent  at  least  of  appearing  in  court  when 
called,  to  be  sworn.  Interesting  questions  have  been  raised  as 
to  his  obedience  to  the  subpoena  to  the  extent  of  testifying  when 
he  has  not  been  compensated.  It  has  been  argued,  and  the 
argument  is  sustained  by  the  decisions  of  courts  of  high  author- 
ity in  some  States,  that  his  knowledge  and  skill,  acquired  by 
study  and  by  experience,  is  his  property,  of  which  he  cannot 
be  deprived  without  just  compensation,  under  his  constitutional 
rights  guaranteed  to  him  by  the  organic  law  of  this  country. 
On  the  other  hand,  in  some  other  States  it  has  been  held  that  he 
is  so  far  a  necessary  part  of  the  judicial  system  that  he  ma}^  be 
called  upon  to  give  the  results  of  his  experience,  knowledge, 
and  skill  forming  his  opinion,  without  payment  other  than  the 
ordinary  compensation  to  witnesses.  It  is  believed,  however, 
that  the  better  opinion  is  the  former;  that  he  does  not  stand  on 
the  same  footing  as  an  ordinary  witness,  whose  province  it  is 
to  testify  solely  to  matters  of  observation  of  fact,  but  that  he 
stands  in  the  position  of  one  who  has  something  to  give ;  some- 
thing to  impart  in  the  way  of  knowledge  or  experience,  which 
is  his  property  as  much  as  any  other  thing  movable  or  im- 
movable of  which  he  is  possessed. 

A  somewhat  different  question  has  arisen  in  the  case  of  a 
witness  who,  like  a  family  physician  or  attending  physician, 
has  learned  facts  and  has  been  paid  for  his  attendance,  or  who 
exacts  paj^ment  for  his  attendance,  as  a  physician  from  his 
patient,  and  this  question  is ;  when  such  a  professional  man  has 
been  called  upon  to  testify  to  the  information  he  thus  attained, 
whether  he  can  be  asked  for,  and  required  to  give,  opinions 
based  on  those  facts?  Necessarily,  having  learned  the  facts  by 
observation,  such  as  the  appearance,  symptoms,  and  actions  of 


EXPERTS,    HOW   SUMMONED    INTO   COURT.  61 

the  patient,  he  is,  when  testifying  as  to  these  matters,  nothing 
more  or  less  than  an  ordinary  witness,  because  he  is  testifying 
to  matters  of  observation.  As  to  these  matters  pubhc  policy 
requires,  except  so  far  as  it  has  been  modified,  or  rather  ex- 
tended, by  our  statutes  which  forbid  testimony  as  to  privileged 
communications,  that  he  must  testify,  the  sarhe  as  any  other 
witness.  But  suppose  that,  having  so  testified  to  the  facts,  he 
is  asked  to  give  his  opinion ;  for  example,  in  an  insanity  case, 
whether  the  symptoms  that  he  found  in  his  patient  led  him  to 
the  belief  as  a  professional  man  of  experience  and  skill  that  his 
patient  was  sane  or  insane.  Tiie  question  is.  Can  he  be  com- 
pelled to  give  that  opinion,  if  he  chooses  to  decline  to  give  it 
without  the  j)romise  or  assurance  of  further  compensation  than 
the  mere  per  diem  fee  and  mileage  of  an  ordinary  witness? 
The  best  authority  is  to  the  effect  that  he  must  so  testify,  the 
reasoning  of  the  court  being  that  his  opinion  is  only  a  part  of 
what  he  derived  from  his  original  relation  of  physician  to  his 
patient.  Wright  v.  The  People,  112  111.,  540;  same  case,  33 
Alb.  L.  J.,  79. 

Same  Rule  in  Civil  and  Criminal  Cases. — The  rule  is  the 
same  whether  the  professional  man  is  called  to  testify  as  an 
expert  in  civil  or  criminal  cases.  In  either  one  he  is  not  obliged 
to  give  an  opinion  as  such,  independent  of  a  personal  knowl- 
edge of  the  facts  in  the  case,  without  being  paid  or  assured 
reasonable  compensation  therefor.  His  proper  course  of  con- 
duct is,  Avhen  he  has  obeyed  the  subpoena  and  is  in  the  presence 
of  the  court  and  has  been  sworn,  and  the  questions  put  by 
counsel  disclose  that  the  object  of  his  examination  is  to  elicit 
from  him  an  opinion,  to  state  to  the  court  that  he  has  not  been 
paid  any  other  compensation  than  that  of  an  ordinary  witness, 
and  that  he  respectfully  declines  to  give  an  opinion  in  the  case 
as  an  expert,  without  compensation  proportionate  to  the  value 
of  his  opinion.' 

'  It  has  been  a  matter  of  great  dis-  pie  v.   Montgomery,    13  Abb.   Pr., 

cussion  whether  an  expert  is  com-  n.    s.,    207;    Ex  parte    Roelker,    1 

pellable    to    testify  on  matters   of  Sprague.    276 ;     Buchanan  v.    The 

opinion,  without  compensation,  the  State,  59Ind.,  1;  Dills  t'.  The  State, 

weight  of  the  decisions  being  that  Id. ,  15 ;  U.    S.    ■».  Howe,    12  Cent, 

he  is  not  bound  to  do  so.     1  Green-  L.    J.,  193;    contra,  6  Central  Law 

leaf  on  Evidence,  §310;  1  Warwick  Journal,   11;  Ex  2mrte  Dement,  53 

Law  Assizes,  158  ;  Parkinson '15.  At-  Ala.,   389  ;  Sumner  ■«.   Tlie  State,   5 

kinson,  31  L.   J.   (n.  s.)  C.  P.,  199;  Tex.,  21  ;  6  Southern  Law  Review, 

Webb  V.  Page,  1  E.  &K.,  25;  Peo-  706.  ;  and  see  generally  Wharton  on 


63  LEGAL   STATUS   OP   PHYSICIANS — BECKER. 

Whether  Witness  Competent  a  Question  fo)  Ci>i(rt  in 
Limine. — After  the  expert  is  placed  upon  the  stand,  as  we  have 
seen,  the  counsel  upon  the  side  of  the  case  by  which  he  is  sum- 
moned interrogates  him  as  to  his  capacity,  the  purpose  of  the 
interrogation  being  that  his  answers  shall  qualify  him  and 
show  him  to  be  an  expert.  Whether  or  not  he  is  an  expert  so 
as  to  permit  the  giving  of  his  opinion  as  part  of  the  case  to  go 
to  the  ]nvj,  is  for  the  court  to  decide  in  limine,  that  is,  at  the 
threshold,  and  as  a  matter  of  discretion,  and  the  exercise  of 
that  discretion,  if  fair  and  reasonable,  will  not  be  disturbed 
upon  appeal  by  the  higher  court.  It  is  permissible,  but  also 
discretionary,  after  the  counsel  calls  the  witness  and  has  ap- 
parently qualified  him,  for  the  counsel  upon  the  other  side  to 
cross-examine  the  witness  as  to  his  qualifications  before  he  is 
examined  in  chief,  with  a  view  of  determining  whether  or  not 
there  are  limitations  upon  those  qualifications  which  should 
prevent  the  court  from  permitting  him  to  testify  as  an  expert. 
The  general  rule  is  as  stated  by  Greenleaf  in  his  work  on 
Evidence,  Sec.  440,  that  it  is  not  necessary  that  the  medical 
expert  should  have  actually  practised  his  profession.  Nor  is  it 
essential  that  the  witness  should  belong  to  any  particular 
school  of  medicine.  The  law  does  not  undertake  to  pass  upon 
conflicting  theories  of  medical  practice,  in  determining  the 
question  of  the  qualification  of  a  medical  expert.  It  is  proper, 
however,  for  counsel  to  inquire  as  to  what  school  of  medicine 
the  witness  is  an  adherent,  because  of  its  importance  in  weigh- 
ing the  value  of  his  testimony  after  it  has  been  given. 

Persons  Not  Duly  Licensed  Sometimes  Held  Not  Compe- 
tent.— It  has  also  been  a  mooted  question  in  those  States  where 
it  is  necessary,  in  order  to  enable  a  person  to  practise  ph3"sic  or 
surgery,  that  he  should  be  licensed,  whether  a  person  practising 
without  a  license,  however  extensive  his  reading  and  practice, 

Evidence,  sec.  380,  note  66,  sec. 456;  his  fee;  that  is,  as  to  whether  he 

Lawson    on    Expert   and    Opinion  expects  to  receive  any  additional 

Evidence  ;    Rogers  on  Expert  Tes-  fee  besides  that  of  an  ordinary  wit- 

tiniony.     As  to  the  compensation  ness,    and   it  has    been    held    that 

being  paid  before  the  testimony  is  where  the  expert  witness  testified 

given,  see  Wharton   on  Evidence,  that  he  was  to  receive  a  fee  which 

sees.  456,  380 ;  People  v.  Montgom-  was  contingent  upon  the  case,  he 

ery,  13  Abb.  Pr. ,  n.  s. ,  207.  was    disqualified   from    testifying. 

It  is  proper,  although  not  neces-  Pollock  -».  Gregory,  9  Bosworth,  N. 

sary,  that  upon  cross-examination  Y.  Superior  Ct.  Rep.,  121-124. 
the  witness  should  be  asked  as  to 


COMPETENCY   OP   WITNESSES.  03 

would  be  considered  qualified  as  an  expert  witness  in  a  court  of 
justice.  This  point,  so  far  as  diligent  examination  discloses, 
has  not  been  determined  in  any  reported  case,  although  it  has 
been  suggested  at  nisi  prius  and  has  been,  in  one  instance 
within  the  knowledge  of  the  writer,  decided  that  he  is  not  to  be 
considered  an  expert  in  matters  involving  medical  knowledge 
and  skill.  The  reasoning  of  the  court  was  that  the  policy  of  the 
State  is  to  prohibit  persons  not  possessing  the  qualifications 
required  to  obtain  a  license,  froin  acting  in  any  capacity  as 
professors  and  practitioners  of  medicine  or  surgery.  If  the 
witness  is  a  member  of  the  profession,  legally  qualified  as  such, 
it  has  been  held  that  he  is  sufficiently  qualified  as  an  expert  if 
he  shows  that  he  possesses  the  average  ability  of  members  of 
his  profession.  Hall  v.  Costello,  48  N.  H.,  176;  Tellis  ?'.  Kidd, 
12  Ala.,  648;  Wharton  on  Evidence,  Sec.  446;  Rogers  on  Ex- 
pert Testimony,  Sees.  17  and  18;  Slocovich  v.  Orient  Mutual 
Ins.  Co.,  108  N.  Y.,  56. 

As  to  the  question  whether  it  is  necessary  that  the  witness 
should  actually  have  practised  his  profession,  see  the  last-cited 
text-writer,  Sees.  43  and  44,  who  seems  to  have  entertained 
views  opposite  to  those  stated  by  Professor  Greenleaf . 

Wharton  on  Evidence,  Sec.  439,  states  the  rule  as  follows : 
"  He  must  have  special,  practical  acquaintance  with  the  imme- 
diate line  of  inquiry  more  than  a  mere  vague,  superficial  knowl- 
edge. But  he  need  not  be  acquainted  with  the  differentia  of 
the  specific  specialty  under  consideration.  ...  A  general 
knowledge  of  the  department  to  which  the  specialty  belongs 
would  seem  to  be  sufficient." 

Interested  Persons  may  still  Testify  as  Experts. — Since 
the  law  forbidding  interested  persons  from  being  witnesses  has 
been  changed,  it  has  been  suggested  that  an  interested  person 
although  otherwise  qualified  might  not  be  a  competent  witness 
to  give  an  opinion  as  an  expert.  But  the  established  doctrine 
is  that  he  may  give  such  an  opinion ;  the  weight  of  it,  however, 
would  be  for  the  jury  to  determine.  Greenleaf  on  Evidence, 
Redfield's  edition.  Sec.  440,  citing  Lockwood  ii.  Lockwood,  2 
Curtis,  309;  Dillon  v.  Dillon,  3  Curtis,  96,  102,  See  also  Dick- 
inson V.  Fitchburg,  13  Gray,  546. 

Testimony  of  Expert,  how  Impeached. — Sometimes,  on 
cross-examination  or  otherwise,  the  fact  becomes  known  that 


64  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

the  witness  who  is  proposed  as  an  expert  has  expressed  an 
opinion  on  the  subject  in  hand  contrary  to  that  which  he  has 
given  upon  the  witness-stand,  and  the  question  has  been  raised 
as  to  establishing  that  fact  at  the  outset  and  before  his  testi- 
mony goes  before  the  jury,  in  order  to  enable  the  trial  judge  to 
determine  whether  he  is  competent.  The  rule  in  that  case  is 
that  the  testimony  as  to  his  prior  expression  of  opinion  is  not 
to  be  received  at  that  time,  but  will  come  properly  up  as 
rebuttal,  he  having  been  asked  upon  his  cross-examination, 
giving  time  and  place,  whether  he  has  made  the  statements 
attributed  to  him.  An  expert  witness  may  in  other  respects  be 
impeached  like  any  other  witness,  that  is,  by  the  oaths  of  persons 
who  know  him  and  have  known  his  reputation,  and  who  testify 
that  his  reputation  for  truth  and  veracity  is  bad  and  that  they 
would  not  believe  him  under  oath.  He  may  also  be  impeached 
by  producing  witnesses  to  prove  that  his  special  knowledge  or 
technical  skill  is  not  reliable  or  adequate  to  the  undertaking 
which  he  has  assumed.  But  this  testimony  must  be  from 
personal  knowledge  of  the  man  and  not  from  general  reputation. 
Wharton  on  Evidence,  Sec.  437 ;  Le  Rose  v.  Commonwealth,  84 
Pa.  St.,  200.' 

General  Rule  as  to  Required  Amount  of  Skill  and  Expe- 
rience Stated. — The  general  rule  may  be  stated  thus,  as  de- 
rived from  these  and  other  authorities : 

^  This  latter  case  holds  that  a  sec-  part  of  his  direct  examination,  but 

ond  expert  may  be  called  to  testify  as  i^art  of  his  cross-examination, 

after  the  first  has  been  thus  chal-  A   medical  expert   is   sometimes 

lenged,  to  support  his  capacity  and  confronted  upon  the  witness-stand 

skill.     The  contrary  rule,  however,  by  long  quotations  from  well  known 

obtains     in    Alabama      (Tellis    v.  medical  text-books,  and  he  is  asked 

Kidd.,  12  Ala. ,  643;  Pugh  t5.  State,  whether  the  doctrines,  opinions,  etc., 

44   Ala.,    33).     Neither  can  an  ex-  there  laid  down  are  sound.     Espe- 

pert  be  contradicted    by  books  of  cially  is  this  done  when  such  doc- 

ecience  ;  that  is,  by  books  of  science  triues  and  oj^inions  are  in  api^arent 

introduced    in    evidence    as     such  discord    with  his    evidence   as   he 

(Wharton  on  Evidence,    666,  721) .  gives  it.     In  such  cases  as  this,  how- 

This  is  so  because  the  rule  is  well  ever  honest,  however  intelligent  and 

established  that  books,  although  of  non-partisan  the  witness  may    be 

great  authority  in  themselves,  may  (except  as  any  opinion  on  one  side 

aot,  even  if  proven  to  be  such,  be  or  the  other  of  a  disputed  question 

placed    in    evidence.      They    may,  may  be  considered  partisan) ,  he  is 

however,    be  read  to  the  witness,  placed  in  a  verj^  difficult  position, 

and  so  be  placed  upon  the  record,  IE  the  citations  and  questions  are 

passage  by  passage,  and  the  witness  from  well-known  authors,  and  he  is 

may    be   asked   whether  he   agrees  a  modest  man,  as  most  men  of  learn - 

with  that  doctrine,  not,  however,  as  ing  are,  it  will  be  difficult  for  him 


SUGGESTIONS   AS   TO   CONDUCT   OF   WITNESSES.  65 

The  extent  of  the  previous  study  and  investigation,  and  the 
amount  of  skill  and  information  which  must  be  shown,  will 
depend  upon  the  facts  of  each  particular  case.  But  some  spe- 
cial and  peculiar  knowledge  or  skill  must  be  established,  the 
amount  of  it  to  be  determined  by  the  trial  judge  in  his  dis- 
cretion. The  possession  of  such  knowledge  and  skill  is  pre- 
sumed in  medico-legal  cases  if  the  witness  is  a  licensed  prac- 
titioner. 

Some  Practical  Suggestions  as  to  Conduct  of  Witnesses 
on  the  Stand. — In  this  preliminary  examination,  the  conduct 
and  demeanor  of  the  witness  are  of  no  little  importance,  because 
it  is  then  and  there  that  he  makes  his  first  impression  upon  the 
court  and  jury.  He  should  be  perfectly  open  and  unreserved 
in  stating  his  means  of  special  information,  in  explaining  what 
are  the  limits  of  his  personal  experience  and  the  extent  of  his 
reading;  but,  at  the  same  time,  it  would  be  well  for  him  to 
avoid  all  appearance  of  self-glorification  and  all  tendency  to 
exaggerate  his  individual  acquirements.  Often  has  it  occurred 
that  expert  witnesses  of  undoubted  capacity  and  honesty,  who 
are  unfortunately  grandiose  and  self-assertive  in  their  manner, 
have,  however  honest  and  able  they  might  be,  lost  entirely  their 
weight  with  the  court  and  jury  by  undue  self-complacency  and 
exaggeration  of  their  personal  qualifications,  during  their  pre- 
liminary examination.  This  is  a  matter  requiring  tact  and 
judgment  and  nerve,  and  should  be  fully  understood  between 

to  deny   that    sucli    authorities  as  to  what  insanity  was,  and  having 

these  have  great  weight,  even  more  stated  what  theories  were  then  tlie 

weight  than  his  experience,  skill,  accepted  ones,  he  was  confronted  by 

and     knowledge    entitle     him     to  counsel    on    his  cross-examination 

claim.     On  the  other  hand,    if   he  with  the  question:   "What  do  jou 

takes  the  bold  course  and  sticks  to  think   of  Dr.  John  P.  Graj-  as  an 

his  opinion,  he  is  cried  down  the  authority  on  that  question?"    and 

winds  by  counsel  in  summing  him  then  with  his  own  writings,  quite 

up,  as  a  man  of  gall,  boldness,  au-  extensive,  of  many  years  before,  in 

dacity  and  egotism.     His  course  is  which  he  had   advocated   theories 

difficult  whichever  way  he  tux'us,  apparently     different    fi'om     those 

but  modesty  as  well  as  honesty  is  which  he  had  professed  upon  the 

usually   the   best   policy.     Perhaps  witness-stand.     Placed  in  this  posi- 

the  best  thing  for  such  a  witness  to  tiou,  the  distinguished  gentleman 

do  under  such  circumstances  is  to  simply  replied:  "It  is  ti'ue  I  cher- 

do   as  once   did   the  great  mental  islied   those  theories  at  that  time, 

alienist  Dr.  John  P.  Gray,  when,  but  I  lived  to  learn   better, "  thus 

having  given  an  opinion  on  a  ques-  substantially  disarming   any  criti- 

tion    of    insanity,    he    was    cross-  cism  that  could  be  made  of  liim  in 

examined  as  to  the  different  theo-  his  capacity  as  a  witness  in  that 

ries  from  time  to  time  prevalent  as  case. 
5 


66  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

counsel  calling  him  and  the  witness,  before  the  witness  is  placed 
upon  the  stand.  In  that  event,  it  will  be  quite  safe  for  the 
witness  to  closely  follow  the  questions  of  counsel  by  his  answers, 
and  to  volunteer  little  or  nothing.  If  his  answers  are  not  full 
and  complete  enough,  counsel  can  renew  the  question  in  the 
same  or  in  other  form  or  carry  the  matter  into  greater  detail. 
If,  on  the  other  hand,  his  answer  is  tuo  full  or  he  appears  too 
eager,  he  may  create  a  prejudice  against  him  which  nothing 
can  overthrow,  and  which  the  art  of  counsel  upon  the  other  side 
in  cross-examination  and  in  making  comments  upon  his  testi- 
mony when  summing  up  before  the  jury,  will  very  effectually 
use  to  destroy  his  weight  as  an  expert.' 

Scope  and  Extent  of  Examination  of  Expert  Witnesses. 
— Having  stated  how  experts  may  be  summoned  and  qualified, 
it  remains  to  consider  the  scope  and  extent  to  which  they  may 
be  examined. 

The  advancement  of  the  sciences  and  the  progress  of  re- 
search in  special  fields  of  knowledge  have  made  expert  testimony 
of  large  importance  during  the  present  century.  The  basis  of 
its  admission  is  the  fact  that  there  are  certain  processes  of 
reasoning  which  an  ordinary  jury  is  incapable  of  performing, 
even  with  the  assistance  of  courts  and  lawj^ers.  'Oftentimes 
in  the  administration  of  justice  in  our  courts,  proof  is  given  of 
circumstances  which  although  admitted  would  have  little  or  no 
significance  in  the  mind  of. an  ordinary  juror,  and  which  he 
would  be  unable  to  contrast  and  compare  with  other  facts,  suc- 
cessfully, without  the  aid  of  those  more  familiar  with  scientific 
matters  and  the  inductive  process  of  reasoning  than  he  is.  In 
such  cases  it  is  necessary  that  the  jury  should  be  specially 
enlightened  by  persons  who  have,  throvigh  training,  skill 
and  experience,  acquired  the  power  to  enlighten  them.  A  com- 
mon instance  and  illustration  of  this  matter  is  to  be  found  in 
the  case  of  homicide  by  poisoning.  A  human  body  is  found 
dead ;  externally  there  may  be  no  indicia  to  show  positively  the 
cause  of  death.  Under  such  circumstance  the  laws  of  all  civil- 
ized countries  permit  what  is  called  a  post-mortem  examination 
by  skilled  phj^sicians,  who,  finding  no  external  evidences  of  the 
cause  of  death,  are  permitted  by  the  officers  of  the  law  to  remove 
the  internal  portions  of  the  body  for  special  and  careful  exam- 
'  For  general  rules  for  the  conduct  of  expert  witnesses  see  infra. 


SCOPE   OF   EXAMINATION   OP   EXPERT   WITNESSES.  67 

ination.  If  this  discloses  traces  of  inflammation  or  of  lesions 
of  an  abnormal  character,  further  power  is  vested  in  the  author- 
ities to  have  at  the  expense  of  the  State  a  chemical  examination 
of  the  internal  organs.  If  this  examination,  which  is  neces- 
sarily long  and  excessively  technical,  results  in  the  discovery 
of  any  poisonous  substance,  such  as  would  produce  death,  and 
if  it  is  found  in  sufficient  quantities  to  produce  death,  these 
persons  who  made  the  post-mortem  examination  and  discovered 
the  outward  indications  of  the  administration  and  effects 
of  the  poison,  and  the  chemists  who  discovered  the  poison 
itself  in  the  tissues  of  the  bg^dj^  in  sufficient  quantities  to  pro- 
duce death,  are  called  as  experts  before  the  jury.  The  post- 
mortem examiners  explain  what  the  appearance  of  the  body 
was,  as  distinguished  from  the  appearances  of  the  body  of  an 
individual  who  had  died  from  natural  causes.  The  chemist 
describes  his  course  of  experimentation,  the  various  deductions 
which  he  made  from  his  experiments,  the  tests  which  he  applied 
in  his  investigation  in  discovering  poison,  and  is  then  allowed 
to  testify  that  the  poisonous  substance  was  found  in  sufficient 
quantities  to  produce  the  physical  appearances  which  the  post- 
mortem examiners  have  described,  and  to  accomplish  the  death 
of  the  human  being  in  whose  body  the  poison  was  found.  It 
is  obvious  that  the  power  of  observation  and  the  skill,  which  the 
skilled  chemists  and  ph^'sicians  used  as  the  basis  of  their  reason- 
ing in  this  case,  were  such  as  an'brdinary  man,  unskilled  and 
inexperienced,  would  not  possess,  and  the  abilit}'  to  use  them 
must  have  come  from  the  study  of  treatises  on  such  subjects, 
and  from  teaching  and  experience,  to  such  an  extent  as  to  en- 
title the  persons  so  testif  j*ing  to  be  considered  by  the  courts  as 
qualified  to  express  an  accurate  and  sound  opinion  on  the  mat- 
ters and  things  under  investigation.  Thus  it  appears  how,  in 
such  cases,  a  departure  became  essential  to  the  successful  ad- 
ministration of  justice,  from  the  strict  rule  that  witnesses  shall 
testif}^  solely  to  matters  of  fact  and  observation,  and  why  it  has 
long  been  considered  that  some  witnesses  must  be  allowed  to 
testify  to  opinions  and  conclusions. 

Again,  in  a  like  case,  a  body  is  found  bearing  evidences  of 
wounds  or  bruises.  The  question  to  be  determined  is  whether 
the3^  were  inflicted  before  or  after  death;  if  before  death, 
whether  they  were  sufficient  to  cause  death.     Some  wounds  and 


68  LEGAL   STATUS   OF   PHYSICIANS — BECKER, 

injuries  might  be  sufficiently  apparent  and  dangerous  so  that 
the  common,  inexperienced  eye  would  at  once  detect  that  they 
were  sufficient  to  cause  death.  But  in  most  instances  this  is 
not  the  case,  and  in  such  instances  the  testimony  of  experts  is 
required  by  the  necessity  of  the  case,  to  show  that  the  wounds 
and  injuries  were  sufficient  to  cause  death. 

The  General  Rules  Stated  as  to  Subjects  for  Expert  Tes- 
timoni/. — Hence  the  general  rule  is,  that  wherever  the  facts  to 
be  investigated  are  such  that  common  experience  and  knowledge 
of  men  do  not  enable  them  to  draw  accurate  conclusions,  but  are 
such  that  the  studj''  and  experience  of  specialists  do  enable 
such  specially  endowed  persons  to  draw  accurate  conclusions, 
then  the  inferences  and  deductions  they  have  drawn  can  be 
testified  to  by  those  who  qualify  themselves  before  the  court  as 
persons  having  sufficient  skill  and  experience  as  such  specialists 
to  entitle  them  to  give  opinions.  The  cases  in  which  expert 
testimony  is  permitted  to  be  given  are  set  forth  in  Rogers  on 
Expert  Testimony,  Sec.  6,  quoting  from  Jones  v.  Tucker  (41  N. 
H.,  540),  as  follows: 

"  1.  Upon  questions  of  science,  skill,  or  trade,  or  others  of 
like  kind. 

"  2.  Where  the  subject-matter  of  inquiry  is  such  that  inex- 
perienced persons  are  unlikely  to  prove  capable  of  forming  a 
correct  judgment  without  such  assistance. 

"  3.  Where  the  subject-mMter  of  investigation  so  far  par- 
takes of  the  nature  of  science  as  to  require  a  course  or  pre- 
vious habit  of  study  in  order  to  the  attainment  of  knowledge 
of  it." 

So  also  Chief  Justice  Shaw  of  the  Supreme  Court  of  Mas- 
sachusetts, in  New  England  Glass  Co.  v.  Lovell  (7  Cushing, 
319),  said: 

"  It  is  not  because  a  man  has  a  reputation  for  sagacity  and 
judgment  and  power  of  reasoning  that  his  opinion  is  admissible 
in  testifying  as  a  witness.  If  so,  such  men  might  be  called  in 
all  cases  to  advise  the  jury,  and  it  would  change  the  mode  of 
trial;  but  it  is  because  a  man's  professional  pursuit,  or  his  pecu- 
liar skill  and  knowledge  of  some  department  of  science  not  com- 
mon to  men  in  general,  enable  him  to  draw  inferences  where 
men  of  common  experience,  after  all  the  facts  have  been  proved, 
would  be  left  in  doubt." 


RULES   AS   TO    SUBJECTS   FOR   EXPERT   TESTIMONY.  69 

To  the  same  effect  see  Muldowney  v.  Illinois  Central  R.  R. 
Co.,  30  Iowa,  472;  Wharton  on  Evidence,  Sec.  436;  Greenleaf 
on  Evidence,  Sec.  441. 

Qualifications  of  this  General  Rule. — The  extent  to  which 
an  expert  witness  can  go  in  giving  his  opinion  is  limited  to 
matters  of  science  and  skill,  and  does  not  extend  to  the  expres- 
sion of  views  on  matters  of  legal  or  moral  observation,  or  the 
manner  in  which  others  would  probably  be  influenced  if  the 
parties  had  acted  in  one  way  rather  than  in  another.  Campbell 
V.  Richards,  5  B.  &  Ad.,  345. 

So  it  has  been  held  that  the  question  whether  a  physician 
has  honorablj"  and  faithfully  discharged  his  duty  in  a  given 
case,  either  to  his  medical  profession  or  to  his  patient,  is  not  a 
question  of  science  but  of  pure  ethics,  upon  which  the  jury  is 
as  competent  to  decide  as  any  one  else,  and  in  such  a  case  an 
opinion  would  not  be  allowed  to  be  given  either  by  another 
medical  practitioner  or  by  a  professor  in  the  science  of  morals. 
Rogers  on  Expert  Testimony,  Sec.  11,  citing  Ramadge  v.  Ryan, 
9  Ring.,  333. 

There  are  also  some  matters  of  fact  which  apparently  tran- 
scend the  dividing  line  between  common  experience  and  judg- 
ment and  scientific  experience  and  judgment,  as  to  which 
expert  testimony  is  not  receivable,  but  the  jury  and  court  must 
weigh  the  facts  and  draw  the  inferences  for  themselves.  An 
interesting  example  of  this  is  foutid  in  the  case  of  Manke  v.  The 
People,  78  N.  Y.,  Oil  (17  Hun,  410),  cited  in  Stephens'  "Di- 
gest of  the  Law  of  Evidence,"  p.  107,  note  H,  decided  in  the 
New  York  Court  of  Appeals  a  few  years  ago.  In  that  case  one 
Adolf  was  killed  by  a  gunshot,  and  pieces  of  paper  were  found 
near  the  scene  of  the  homicide  bearing  certain  marks.  An  ex- 
pert was  called  upon  to  say  whether  they  were  powder-marks, 
and  whether  the  condition  of  the  paper  was  such  that  in  his 
opinion  it  was  wadding  which  had  been  fired  from  a  gun.  This 
evidence  was  held  to  be  inadmissible  by  the  General  Term  of 
the  Supreme  Court,  and  this  decision  was  affirmed  by  the  Court 
of  Appeals.  These  courts  held  that  the  question  as  to  whether 
this  was  a  wad  fired  from  a  gun  was  a  matter  which  the  jury 
was  as  competent  to  judge  of  as  the  witness.  In  delivering  the 
opinion  at  General  Term,  Presiding  Justice  Talcott  said  that 
this  case  was  very  close  to  the  border  line,  but  in  his  judgment 


70  LEGAL   STATUS    OP   PHYSICIANS — BECKER. 

it  was  beyond  the  province  of  experts  and  within  the  province 
of  jurors. 

Nevertheless,  in  that  case  the  evidence  of  chemists  who  had 
examined  the  wadding,  and  had  discovered  the  marks  on  it 
which  were  said  to  be  powder-marks,  and  upon  analysis  had 
determined  that  they  were  powder-marks,  or  that  they  were 
marks  of  powder  which  had  exploded,  would  have  been  clearly 
admissible. 

The  subjects  concerning  which  medical  men  may  be  called 
upon  to  testify  as  experts  are  as  numerous  as  the  diseases,  in- 
juries, mental  and  physical  conditions  of  the  human  race  which 
fall  within  the  range  of  the  practice  of  medicine  and  surgery. 
It  is  therefore  practically  impossible  to  give  them  in  detail. ' 

Practical  Suggestions  and  Admonitions  Embodied  in 
Rules. — It  is  deemed  advisable  that  the  following  practical 
suggestions  and  admonitions  to  physicians,  concerning  their 
duties  as  expert  witnesses,  shall  here  be  given. 

First :  A  physician  should  refuse  to  testify  as  an  expert  un- 
less he  is  conscious  that  he  is  really  qualified  as  an  expert. 

Second:  After  accepting  the  responsibility,  his  first  duty 
should  be  to  make  a  diligent  examination  and  preparation  for 
his  testimony,  unless  it  is  upon  a  subject  with  which  he  is 
familiar  and  which  he  is  satisfied  that  he  has  already  exhausted, 
by  reading  the  best  authorities  that  he  can  find,  and  by  careful 
reflection  upon  particular  questions  as  to  which  his  opinion 
will  be  asked. 

Third :  Where  he  is  to  make  an  examination  of  facts,  such 
as  the  post-mortem  examination  of  a  body,  a  chemical  analysis 
or  an  examination  of  an  alleged  insane  person,  he  should  insist 

^  The  principal  classes  of  such  Also  causes  of  alleged  sterility  or 
subjects  may,  however,  be  briefly  pregnancy;  time  pregnancy  has  ex- 
stated  as  follows :  isted ;  also  cases  of  alleged  impo- 

1.  Causes  of  death;  especially  in  tency. 

cases   of    homicide,    suicide,    acci-  4.  Rape,  abortion,  bastardy,  ped- 

dent,  etc.,  including  poisoning.  erasty,    onanism,    masochism,    and 

!i.  Causes,  nature,  and  extent  of  many  other  matters  relating  to  the 

personal   injuries,  by  violence,  ac-  sexual  organs. 

cidents,  explosions,    railway  disas-  5.  Malpractice    cases,     involving 

ters,  collision  between  vessels,  etc.  the  degree  of  care  and  skill  usual, 

3.  Birth  of  infants  ;  was   infant  and  that  used  in  the  case  under  in- 
born dead   or  alive ;   if  dead,  was  vestigation,  and  involving  delicate 
death  the  result   of  natural  causes  questions  as  to  the  propriety  of  the 
or  of  internal  violence ;  age  of  in-  ti'eatment  adopted,  etc. 
fant  at  the  time  of  birth  or  death. 


PRACTICAL   SUGGESTIONS   AND   ADMONITIONS.  71 

upon  having  ]3lenty  of  time  and  full  opportunity  for  doing  his 
work  thoroughly.  He  should  take  particular  pains  to  make 
his  examination  open  and  fair,  and,  if  possible,  should  invite 
opposing  experts  to  co-operate  with  him  in  it. 

Fourth :  He  should  be  honest  with  his  client  before  the  trial 
in  advising  him  and  giving  him  opinions,  and  upon  the  trial 
should  preserve  an  absolutely  imjDartial  attitude,  concealing 
nothing,  perverting  nothing,  exaggerating  nothing. 

Fifth :  On  the  preliminary  examination  as  to  his  qualifica- 
tions as  a  witness  he  should  be  frank  and  open  in  answering 
questions.  He  should  state  fully  the  extent  and  the  limits  of 
his  personal  experience  and  of  his  reading  upon  the  subject, 
without  shrinking  from  responsibility,  yet  without  self-glorifi- 
cation. 

Sixth :  He  should  be  simple,  plain,  and  clear  in  his  statement 
of  scientific  facts  and  principles,  avoiding  the  use  of  technical 
language,  and  trying  to  put  his  ideas  in  such  form  that  they 
will  be  grasped  and  comprehended  bj'  men  of  ordinary  educa- 
tion and  intelligence. 

Seventh :  He  should  avoid  stating  any  conclusions  or  prin- 
ciples of  which  he  is  not  certain,  but  having  an  assurance  that 
he  is  right  he  should  be  firm  and  positive.  He  should  admit 
the  limitations  of  his  knowledge  and  ability.  Where  a  ques- 
tion is  asked  which  he  cannot  answer,  he  should  not  hesitate  to 
say  so ;  but  he  should  refuse  to  be  led  outside  the  subject  of 
inquiry,  and  should  confine  his  testimony  to  those  scientific 
questions  which  are  really  involved  in  the  case,  or  in  his  exam- 
ination of  the  case. 

Eighth :  And  finally,  he  should  always  bear  in  mind  that  at 
the  close  of  his  testimony  an  opportunity  is  usually  given  to 
him  to  explain  anything  which  he  may  be  conscious  of  having 
said,  which  requires  explanation ;  and  partial  statements  which 
need  a  qualification  to  make  them  a  truth.  This  is  the  physi- 
cian's opportunity  to  set  himself  right  with  the  court  and  with  the 
jury.  If  the  course  of  the  examination  has  been  unsatisfactory 
to  him,  he  can  then,  by  a  brief  and  plain  statement  of  the  gen- 
eral points  which  he  has  intended  to  convey  b}"  his  testimony, 
sweep  away  all  the  confusion  and  uncertainty  arising  from  the 
long  examination  and  cross-examination,  and  can  often  succeed 
in  producing  for  the  first  time  the  impression  which  he  desires 


72  LEGAL   STATUS   OF   PHYSICIANS— BECKER. 

to  produce,  and  can  present  the  scientific  aspects  of  the  case 
briefly  and  correctly. 

Probably  no  man  was  ever  so  gifted  as  to  be  able  in  practice 
to  carr/  out  all  of  these  principles  in  giving  medical  testimony. 
If  he  could,  he  would  be  the  ideal  expert  witness.  But  the 
principles  are,  after  all,  simple  and  easily  followed  in  the  main. 
Any  physician  who  knows  his  subject  and  who  has  a  clear  head 
and  the  ordinary  faculty  of  expression,  by  observing  these  prin- 
ciples can  make  himself  invaluable  as  an  expert  witness.  There 
is  no  branch  of  the  profession  which  brings  a  broader  fame, 
greater  influence,  or  larger  emoluments  than  this.  There  is  no 
branch,  on  the  other  hand,  in  which  men  of  real  ability  make 
more  lamentable  failures. 


CHAPTER    VI. 

MALPRACTICE. 

Definition. — Malpractice  may  be  defined  to  be — 

1st.  Wilful  acts  on  the  part  of  a  physician  or  surgeon 
toward  a  person  under  his  care,  by  which  such  person  suffers 
death  or  injury; 

2d.  Acts  forbidden  by  express  statute,  on  the  part  of  a  phy- 
sician or  surgeon,  toward  a  person  under  his  care,  by  which 
such  person  suffers  death  or  injury ; 

3d.  Negligent  acts  on  the  part  of  a  physician  or  surgeon  in 
treating  a  patient,  by  means  of  which  such  patient  suffers  death 
or  unnecessary  injury. 

These  various  divisions  will  be  considered  in  the  order  in 
which  they  are  above  set  forth. 

Wilful  Malpractice.— The  cases  which  fall  within  the 
first  two  divisions  of  this  definition  are  such  acts  as  render 
the  medical  man  liable  to  punishment  in  a  criminal  prosecution, 
and  may  not  necessarily,  although  in  some  instances  they  may, 
constitute  grounds  of  liability  in  a  civil  suit  against  him. 

As  examples  of  the  first  class  of  cases  may  be  cited  those 
instances,  happily  not  numerous  in  the  annals  of  the  profes- 
sion, where  a  physician  or  surgeon  when  treating  a  female 
patient  has  had  carnal  connection  with  her,  representing  that 
he  was  using  that  method  of  treating  her  to  cure  her  disease. 
Such  a  case  was  Reg.  v.  Case,  1  Eng.  Law  &  Eq.,  544  (s.  c, 
1  Den.  C.  C,  580).' 

Honest  Intent  no  Defence  in  Such  Cases. — In  Reg.  v. 
Reed,  1  Den.  C.  C,  377  (s.  c,  2  Car.  &  K.,  967),  it  was  con- 
tended as  a  defence  that  the  defendant  really  believed  that  he 
was  curing  his  patient  by  treating  her  in  this  extraordinary 
way.     The  Court,  per  Wildes,  C.  J.,  brushed  aside  this  conten- 

'  See  also  1   Bishop  Crim.  Law,  sec.  36 ;    Rex  v.  Romiski,  1  Moody,  19 ; 
Reg.  V.  Ellis,  2  Car.  &  K. ,  470. 

73 


74  LEGAL   STATUS   OP   PHYSICIANS— BECKER. 

tion  with  scorn,  saying :  "  The  notion  that  a  medical  man  may 
lawfully  adopt  such  a  method  of  treatment  is  not  to  be  tolerated 
in  a  court  of  justice ;"  and  in  this  case  and  in  others,  convictions 
have  been  sustained  for  the  crime  of  rape  or  of  attempting  to 
commit  rape.' 

Another  example  of  wilful  malpractice  would  be  wilful 
neglect  of  a  patient  by  his  medical  attendant,  who  became  in- 
toxicated voluntarily,  though  this  will  generally  come  under 
the  second  subdivision,  as  most  states  and  countries  have  enacted 
statutes  making  it  a  criminal  offence  to  practise  medicine  or 
surgery  when  intoxicated. 

Acts  Forbidden  by  Statute. — Within  the  second  sub- 
division of  the  definition,  or  acts  declared  unlawful  by  statute, 
fall  the  cases  of  committing  or  attempting  to  commit  an  abor- 
tion, and  cases  of  prescribing  for  or  treating  a  patient  by  one 
voluntarily  intoxicated.  If  the  abortion  is  attempted  without 
the  knowledge  or  consent  of  the  woman,  and  under  the  pretence 
of  performing  a  necessary  operation  upon  her  to  cure  disease, 
undoubtedly  the  physician  would  be  liable  to  a  criminal  pros- 
ecution by  the  State  for  the  offence  of  committing  an  abortion 
and  to  civil  action  by  her  to  recover  damages.  If  the  abortion 
was  committed  with  her  consent,  while  she  would  have  no 
right  of  action  against  him  for  damages,  he  would  be  liable  to 
criminal  prosecution  under  the  statute. 

Abortion  Not  a  Crime  by  the  Commoii  Laiv. — At  common 
law  it  was  not  a  crime  to  commit  an  abortion  with  the  mother's 
consent  if  the  child  had  not  quickened.  In  Mitchell  v.  Com.,  78 
K}'.,  204  (s.  c,  39  Am.  Reports,  227),  the  Court,  per  Hines,  J., 
says :  "  After  a  patient  investigation  we  are  forced  to  the  con- 
clusion that  it  was  never  called  a  punishable  offence  at  common 
law  to  produce,  with  the  consent  of  the  mother,  an  abortion  prior 
to  the  time  when  the  mother  became  quick  with  child.  It  was 
not  even  murder  at  common  law  to  take  the  life  of  the  child 
at  any  period  of  gestation,  even  in  the  very  act  of  delivery." 
See  also  Evans  v.  People,  49  N.  Y.,  8G. 

The  inhumanity  and  danger  to  societA'  of  this  rule  became 
manifest  at  a  very  early  period,  and  both  in  England  and  in 

'  In  such  cases  as  these  the  patient  had  taken  wilful  and  wicked  ad- 
would  have  a  right  of  action  in  the  vantage  of  his  professional  relation 
civil  courts  for  damages  against  the  to  her,  to  do  her  a  grievous  wrong, 
physician  or   surgeon,    because  he 


ACTS   FORBIDDEN   BY   STATUTE.  75 

this  country  statutes  were  adopted,  varying  somewhat  in  the 
degree  and  kind  of  punishment  and  in  the  nomenclature  of  the 
crime,  but  all  of  them  making  the  offence  of  committing  an 
abortion,  no  matter  at  what  stage  of  gestation,  a  crime.' 

The  Common-Laiv  Doctrine  Criticised. — Professor  Elwell 
in  his  A^aluable  work  on  "  Malpractice,  Medical  Evidence  and 
Insanity,"  pp.  250,  251,  makes  the  following  remarks  upon  this 
subject :  "  The  idea  once  existed  quite  generallj-,  and  it  still 
exists  to  sofne  extent,  that  there  is  no  offence  in  destroying  the 
embryo  or  foetus  before  there  is  a  manifest  knowledge  of  life  by 
the  mother,  derived  from  motion  of  the  child  called  'quicken- 
ing. '  How  absurd  to  suppose  that  there  is  no  life  until  the 
mother  can  feel  the  muscular  motions  of  the  child!  As  well 
might  we  deny  the  vitalit}'  of  the  blood  because  it  cannot  be  felt. 
The  muscular  tissues,  and  even  the  bones  to  which  thej"  are  at- 
tached, must  have  some  degree  of  substance  before  there  can  be 
motion,  and  of  course  this  development  depends  upon  life. 
Though  this  foolish  notion  is  now  fully  exploded  in  medicine,  it 
still  lingers  in  the  popular  mind,  and  doubtless  leads  to  much 
crime.  The  life  of  the  foetus  or  embryo  immediately  after  con- 
ception is  just  as  positive  physiologically  as  at  any  subsequent 
period.  Quickening  being  an  incident  or  sign  in  the  course 
of  development  of  the  foetus,  it  indicates  not  the  commence- 
ment of  a  new  state  of  existence,  but  only  a  new  manifesta- 
tion of  pre-existing  life.  ...  It  is  uncertain  in  its  appear- 
ance, sometimes  coming  on  at  three  months,  sometimes  at  six 
months,  and  sometimes  not  at  all." 

Legal  Definitions  of  Terms,  "  Quick  with  Child,"  etc. — • 
In  Evans  v.  People,  49  N.  Y.,  8G,  following  R.  v.  Wycherly, 
8  C.  &  P.,  262,  it  was  held  that  a  woman  is  "quick  with  child" 
from  the  period  of  conception  after  the  commencement  of  gesta- 
tion, but  is  "pregnant  with  quick  child"  only  when  the  child  has 
become  "quickened  in  the  womb."  This  distinction  has  been 
discussed  in  State  v.  Cooper,  2  Zab.,  N.  J.,  52,  and  since  the 
Evans  case,  the  same  court  in  New  York  State  has  held  that 
the  expression,  "woman   with   child,"  means  "pregnant  wo- 

'The  Pennsj^lvania  courts   at  an  stinct  with  life  iu  embryo  and  the 

early  period  refused  to  follow  this  process  of  K<?station  has  begun  the 

common-law    doctrine,     and    held  crime  may  be  perpetrated.     Mills  y. 

that  the  moment   the  womb  is  in-  Com.,  13  Pa.  St.,  631. 


76  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

man."  Eckhardt  v.  People,  83  N.  Y.,  42  (s.  c,  38  Am.  Rep., 
4G2). 

Death  of  Child  by  Abortion. — If,  in  attempting  to  produce 
an  abortion,  the  child  is  caused  to  be  born  alive  but  before  the 
end  of  the  period  of  gestation,  and  when  it  is  not  capable  of 
sustaining  life,  and  it  dies,  the  person  producing  the  abortion 
and  bringing  the  child  into  the  world  at  this  time  and  in  this 
manner  is  guilty  of  murder.  Wharton's  Crim.  Law,  sec.  942; 
Rex.  V.  West,  2  Cox  Crim.  Cases,  500;  Com.  v.  Brown,  14 
Gray,  Mass.,  419. 

Death  of  Mother  by  Abo7^tion. — So  also  where  in  con- 
sequence of  producing  an  abortion  the  death  of  the  mother 
occurs,  the  person  producing  the  abortion  is  guilty  of  murder 
at  common  law.  4  Blackstone's  Com.,  201;  1  Bishop's  Crim. 
Law,  328.  In  some  of  the  States,  however,  these  offences  are 
declared  to  be  only  manslaughter. 

Further  consideration  of  the  subject  of  abortion  will  be  had 
under  that  title  in  another  part  of  this  work. 

Statutes  Geyierally  Except  Abortions  Necessary  to  Save 
Life. — It  should  be  noted  here,  however,  that  nearly  all  the 
statutes  which  define  and  punish  the  crime  of  abortion,  or  the 
crime  of  manslaughter  or  murder  committed  in  consequence  of 
abortion,  declare  that  when  it  is  necessary  to  produce  a  mis- 
carriage in  order  to  save  life,  the  act  of  doing  so  is  excepted 
from  the  effect  of  the  statute. 

Negligent  Malpractice. — Under  the  third  subdivision  of 
the  definition,  viz.,  when  by  reason  of  the  negligent  acts  on  the 
part  of  the  physician  or  surgeon  the  patient  suffers  death  or  un- 
necessary injurj^,  may  be  placed  the  most  numerous  cases  of  mal- 
practice, according  to  the  generally  accepted  meaning  of  the  term. 

Criminal  Liability  for  Negligent  Malpractice. — It  is 
manifest  that  not  every  degree  of  negligence  which  causes 
death  or  injury  ought  to  render  the  physician  or  surgeon 
liable  to  indictment  and  punishment  for  a  crime.  The  general 
theory  of  the  criminal  law  is  based  upon  the  doctrine  that  in 
order  to  constitute  a  crime  there  must  be  either  an  intent  to 
do  the  wrong,  or  such  a  degree  of  negligence  in  the  performance 
of  a  given  act  as  to  supply  the  place  of  the  intent  to  do  wrong, 
and  require  punishment  for  the  protection  of  society,  upon  the 
ground  that  the  carelessness  of  the  defendant  is  so  great  as  to 


NEGLIGENT   MALPRACTICE.  77 

make  it  necessary  and  proper  to  punish  him,  in  order  to  deter 
others  from  following  his  example. 

Doctrine  of  Leading  Case  of  Com.  v.  Thompson. — In 
Com.  V.  Thompson  (6  Mass.,  134),  Parsons,  C.  J.,  observes: 
"  There  was  no  evidence  to  induce  the  belief  that  the  prisoner  by 
his  treatment  intended  to  kill  or  injure  the  deceased  and  the 
ground  of  express  malice  must  fall.  It  has  been  said  that  im- 
plied malice  may  be  inferred  from  the  rash  and  presumptuous 
conduct  of  the  prisoner  in  administering  such  violent  medi- 
cines. Before  implied  malice  can  be  inferred,  the  judges  must 
be  satisfied  that  the  prisoner  by  his  treatment  of  his  patient 
was  wilfully  regardless  of  his  social  duties,  being  determined 
on  mischief.  ...  To  constitute  manslaughter,  the  killing 
must  have  been  the  consequence  of  some  unlawful  act.  Now 
there  is  no  law  which  prohibits  any  man  from  prescribing  for 
a  sick  person  with  his  consent ;  and  it  is  not  a  felon}^  if  through 
his  ignorance  of  the  qualit}^  of  the  medicine  prescribed,  or  of 
the  nature  of  the  disease,  or  of  both,  the  patient,  contrary  to 
his  expectations,  should  die.  The  death  of  a  man  killed  by 
voluntarily  following  a  medical  prescription  cannot  be  adjudged 
felony  in  the  party  prescribing  unless  he,  however  ignorant  of 
medical  science  in  general,  had  so  much  knowledge  or  probable 
information  of  the  f^tal  tendency  of  the  prescription  that  it  may 
be  reasonably  presumed  by  the  jury  to  be  an  act  of  wilful  rashness 
at  least,  and  not  of  honest  intention  and  expectation  to  cure." 

The  Doctrine  of  the  Thompson  Case  Too  Broad. — This 
lax  statement  of  the  law,  made  by  the  learned  chief  justice  in 
this  case,  has  been  much  doubted  and  criticised.  It  ap- 
pears to  be  unsound  in  the  length  to  which  it  goes  in  requir- 
ing, in  order  to  constitute  criminal  liabilit}',  what  may  be 
termed  excessive  gross  carelessness  or  wilful  gross  carelessness. 
It  apparently  runs  counter  to  the  prevailing  opinions  of  the 
English  judges,  and  to  the  later  decisions  of  the  courts  in  the 
United  States,  although  it  is  followed  and  approved  in  Rice  v. 
The  State,  8  Mo.,  561. 

In  Rex  V.  Long  (4  Car.  &  P.,  308-310),  Park,  J.,  said:  "I 
call  it  acting  wickedly  when  a  man  is  grossl}"  ignorant  and  yet 
affects  to  cure  people,  or  when  he  is  grossly  inattentive  to  their 
safety." 

So  in  Rex  v.  Spiller  (5  Car.  &  P.,  353),  the  Court  said :  "  If 


78  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

a  person,  whether  a  medical  man  or  not,  professes  to  deal  with 
the  life  and  health  of  another,  he  is  bound  to  use  competent 
skill  and  sufficient  attention;  and  if  he  causes  the  death  of  an- 
other through  gross  want  of  either  he  will  be  guilty  of  man- 
slaughter." 

Bishop,  in  his  work  on  Criminal  Law,  lays  down  the  rule 
that  not  every  degree  of  carelessness  renders  a  practitioner 
liable  to  criminal  prosecution,  and  that  it  must  be  gross,  or,  as 
more  strongly  expressed,  "  the  grossest  ignorance  or  most  crim- 
inal inattention."  ' 

Nevertheless  he  quotes  with  approval  (2  Bishop  Crim.  Law, 
264)  the  remark  of  Willes,  J.,  that  a  medical  man  is  taking  a 
leap  in  the  dark  if  he  knew  he  was  using  medicines  beyond  his 
knowledge;  and  also  the  remarks  of  Bayley,  J.,  in  Rex  v.  Simp- 
son (1  Lewin,  172),  who  said  in  that  case:  "I  am  clear  that  if 
a  person  not  having  a  medical  education,  and  in  a  place  where 
a  person  of  a  medical  education  might  be  obtained,  takes  it 
upon  himself  to  administer  medicines  which  may  have  an  in- 
jurious effect,  and  such  medicines  destroy  the  life  of  the  person 
to  whom  they  are  administered,  it  is  manslaughter.  The  party 
may  not  mean  to  cause  death,  or  the  medicine  may  produce 
beneficent  effects,  but  he  has  no  right  to  hazard  medicine  of 
a  dangerous  tendency  when  medical  assistance  can  be  obtained. 
If  he  does,  he  does  it  at  his  peril."  "^ 

Gross  Negligence  Defined. — In  general  it  may  be  stated 
that  gross  negligence  is  necessary  to  constitute  criminal  liabil- 
ity, but  this  may  be  predicated  upon,  or  inferred  from,  such 
want  of  ordinary  care  and  skill  as  shows  gross  ignorance,  or 
such  want  of  attention  as  indicates  wilful  disregard  of  the  well- 
known  laws  of  life  and  health.^ 

Gross  Negligence  Resulting  in  Injury  a  Misdemecmor. — 
It  has  also  been  held  that   although  death   does   not  but  in- 

'1  Bishop  Crim.    Law,  sec.    217,  561;    Fairlee  ■«.  People,   11  111.,   1; 

citing  Rex  ■».    Williamson,   3  Car.  Holmes  v.  State,   23  Ala.,  17;   Rex 

&P.,  635.  V.  Spilling,  2  M.  &  Rob.,   107;  Fer- 

'  The  same  learned  and  philosoph-  guson's  Case,  1  Lew.,  181;  Thomas 

ical   text-writer    (2    Bishop  Crim.  v.    Winchester.     2    Selden,    N.    Y. 

Law,    sec.    664)  compares  the  Eng-  Court  of  App.,  397;  Com.  ■?).  Pierce, 

lish   and    American  cases  and  de-  138  Mass.,    165,    and    cases    cited; 

clares  that  the   difference  between  Stated).  Hahn,  38  Ark.,  605;  "Wliar- 

them  is  more  apparent  than  real.  ton's    Crim.    Law,   sec.    1015  ;    El- 

^See  Rice  v.   The   State,  8  Mo.,  well  on  Malpractice,  etc.,  238,  239. 


NEGLIGENT   MALPRACTICE.  79 

jury  does  ensue,  as  the  result  of  gross  negligence  or  inattention, 
that  constitutes  a  misdemeanor  punishable  criminally.' 

In  Determining  Degree  of  Negligence  Circumstances 
and  Conditions  Govern. — It  should  be  noted,  however,  that 
the  circumstances  and  conditions  attending  the  act  of  alleged 
criminal  malpractice  should  be  given  much  weight.  So  also 
should  due  weight  be  given  to  the  advancement  of  knowledge 
and  education  in  the  world  in  general,  and  in  the  medical 
profession  in  particular.  In  an  early  English  case,  one  of  the 
judges  remarked  that  not  as  much  knowledge  and  skill  could 
be  expected  of  a  surgeon  or  phj^sician  in  a  sparsely  settled 
country  district  as  in  a  city,  and  that  he  was  at  a  loss  to  know 
what  degree  of  knowledge  and  skill  should  be  required  of  such 
a  person.  But  in  Gram  v.  Boener,  5G  Ind.,  447,  Worden,  J., 
said  :  "  It  seems  to  us  that  physicians  or  surgeons  practising  in 
small  towns,  or  in  poorly  or  sparsely  settled  country  districts, 
are  bound  to  possess  and  exercise  at  least  the  average  degree  of 
skill  possessed  and  exercised  by  the  profession  in  such  localities 
generall}^.  It  is  not  true,  as  we  think,  to  saj'  that  if  a  physician 
and  surgeon  has  exercised  such  a  degree  of  skill  as  is  ordinarily 
exercised  in  the  particular  locality  in  which  he  practises,  that 
would  be  sufficient.  There  might  be  but  few  practising  in  the 
given  locality,  all  of  whom  might  be  quacks,  ignorant  pretenders 
to  knowledge  not  possessed  by  them,  •and  it  would  not  do  to 
say  that  because  one  possessed  and  exercised  as  much  skill  as 
the  other,  he  could  not  be  chargeable  with  the  want  of  reasonable 
care  and  skill."  ^ 

Unlicensed  Practitioner  Causing  Death  Guiltij  of  Man- 
slaiighter. — Since  the  adoption  by  most  civilized  states  and 
countries  of  the  salutary  practice  of  regulating  bj^  statute  the 
practice  of  medicine  and  surgery,  and  forbidding  j^ersons  not 
duly  licensed  from  practising,  and  making  it  a  misdemeanor 
to  violate  -any  of  these  statutes,  it  is  clear  that  any  person  not 
having  the  requisite  medical  education  and  a  license,  who  at- 
tempted to  administer  drugs  and  medicines  or  to  perform  op- 

'1  Bishop  Crim.   Law,  sec.   558,  131 ;  Gates  ■».  Fleisher,  67  Wis.,  28fi  ; 

citing  Groenvelt's  case,  1  Lord  Ray-  Smothers  v.   Hauks,  34  Iowa,    286  ; 

mond,  213;  Rex  v.  Long,  4C.  &P.,  Ahnond  v.   Nugent,    34  Iowa,    300; 

398.  Hairev.  Reese,  7  Phila.  (Pa.),  138; 

^  See  also  Kelsey  v.  Hay,  84  Ind.,  Nelson  v.  Harrington,  72  Wis.,  591. 
189 ;    Small  v.  Howard,   128  Mass. , 


80  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

erations,  and  through  -want  of  ordinary  knowledge  and  skill 
caused  the  death  of  another,  would  be  held  guilty  of  man- 
slaughter, because  he  brought  about  the  death  while  he  himself 
was  engaged  in  a  violation  of  the  law.  In  some  states  where 
no  discrimination  in  this  respect  is  made  between  misdemeanors 
and  felonies,  the  crime  would  be  murder,  punishable  by  death ; 
and  it  has  always  been  the  law  that  an  empiric  or  quack  holding 
himself  out  as  a  regular  physician  is  bound  to  have  and  exhibit 
the  degree  of  skill  and  care  which  he  professes,  and  will  be 
strictly  held  to  the  standard  of  skill  of  educated  and  licensed 
medical  men.' 

As  to  the  legal  meaning  of  the  term  "  ordinary  care  and 
skill,"  and  the  rules  of  evidence  applicable  in  cases  of  malprac- 
tice, a  full  discussion  will  be  had  below,  when  considering  the 
subject  of  civil  liability  for  malpractice. 

Civil  Liability  for  Malpractice. 

Any  person  holding  himself  out  to  be  a  physician  or  sur- 
geon, or  anj^  physician  or  surgeon,  who  is  guilty  of  malpractice, 
is  liable  for  damages,  to  be  recovered  in  a  civil  action,  insti- 
tuted by  the  person  injured,  or  by  those  having  a  legal  right  to 
such  person's  services.  This  is  so  whether  the  injured  person 
actually  employed  the  defendant  to  prescribe  or  treat  him,  or 
not.  The  liability  flows  out  of  the  relationship,  without  regard 
to  the  element  of  employment,  and  it  may  result  from  negli- 
gence in  treatment,  or  in  prescribing,  or  in  giving  information 
and  instructions  to  the  patient  as  to  how  to  take  care  of  himself 
when  under  treatment.  The  rules  of  law  applicable  to  the 
duties  of  a  physician  to  his  patient  are  stated  and  the  authorities 
supporting  them  cited  in  Chapter  IV.  of  this  work.^ 

Ordinary  Care  and  Skill  Only  Required. — The  leading 
cases  in  America  on  the  subject  of  civil  liability  for  mal- 
practice are:  Leighton  v.  Sargent,  7  N.  H.,  460,  and  Car- 
penter V.  Blake,  60  Barb.,  485  (s.  c.  on  appeal,  75  N.  Y.,  12). 
In  the  former  case  the  Court  said :  "In  a  science  encumbered 

'  Ruddock  V.  Low,  4  F.  &  F. ,  519  ;  Roper,  2  F.  &  F.,  783  ;  Carpenter  v. 

Musser  v.  Chase,  29  Ohio  St.,  577.  Blake,  60  Barb.,  485,  50  N.  Y.,  696, 

^  See    particularly   Gieselman    v.  10  Hun,  358,  75  N.  Y. ,  12  ;  Leighton 

Scott,  25  Ohio  St.,  86;  Lanphier  v.  v.  Sargent,  7  N.  H.,  460. 
Phipos,  8  C.   &    P.,    475;    Pym  v. 


CIVIL   LIABILITY   FOR   MALPRACTICE,  81 

with  so  many  sources  of  error  and  difficulties,  it  is  obvious 
what  cause  we  have  for  proceeding  with  the  utmost  caution, 
and  for  advancing  from  step  to  step  with  the  greatest  circum- 
spection. It  is  in  consideration  of  those  peculiar  difficulties 
that  beset  and  encompass  the  physician  and  surgeon,  that  all 
enlightened  courts  have  held  that  but  ordinary  care  and  skill 
shall  be  required  of  them,  and  that  mere  errors  of  judgment 
shall  be  overlooked,  if  the  general  character  of  treatment  has 
been  honest  and  intelligent,  and  that  the  result  of  the  case  shall 
not  determine  the  amount  of  the  responsibility  to  which  he  is 
held;  and  that  when  unskilfulness  or  negligent  treatment  of 
his  patient  is  charged  to  a  surgeon,  it  is  not  enough  to  show 
that  he  has  not  treated  his  patient  in  that  mode  or  has  not  used 
measures  which  in  the  opinion  of  others,  though  medical  men, 
the  case  required ;  because  such  evidence  tends  to  prove  errors 
of  judgment,  for  which  the  defendant  is  not  responsible,  as 
much  as  it  goes  to  prove  a  want  of  reasonable  skill  and  care  for 
which  he  may  be  responsible.  Alone  it  is  not  evidence  of  the 
latter,  and  therefore  a  party  must  go  further  and  prove,  bj^ 
other  evidence,  that  the  defendant  assumed  the  character  and 
undertook  to  act  as  a  physician  without  the  education,  knowl- 
edge, and  skill  which  entitled  him  to  act  in  that  capacity." 

In  Carpenter  v.  Blake,  upon  the  last  appeal  (75  N.  Y.,  12), 
it  was  said  that  the  reasonable  ordinary  care  and  diligence 
which  the  law  requires  of  physicians  and  surgeons  is  that 
which  persons  engaged  in  the  same  general  line  of  practice 
have  and  exercise  in  like  cases. ' 

Story''s  Statement  of  the  Rule. — Story  in  his  work  on 
Bailments,  p.  433,  with  his  usual  felicitous  method  of  state- 
ment says :  "  In  all  cases  where  skill  is  required  it  is  to  be  un- 
derstood that  it  means  ordinary  skill  in  the  business  or  em- 
ploj^ment  which  the  bailee  undertakes ;  for  he  is  not  presumed 
to  undertake  for  extraordinary  skill,  which  belongs  to  a  few 
men  only  in  his  business  or  emploN^ment,  or  for  extraordinary 
endowments  or  acquirements.  Reasonable  skill  constitutes  the 
measure  of  the  engagement  in  regard  to  the  thing  undertaken." 

Occult  Influences  Should  be  Considered  by  Laivyers  and 

'Synonymous  terms  with    "rea-      376;    "ordinary    care    and    skill," 
sonable  care  "  are  "  fair  knowledge      Heath  v.  Glisan,  3  Oregon,  64. 
and  skill, "  Jones  v.  Angell,  95  Ind., 

6 


82  LEGAL  STATUS   OF  PHYSICIANS — BECKER. 

Judges. — In  this  connection  it  should  be  borne  in  mind  by 
lawyers  and  judges,  that  in  the  case  of  a  physician  treating 
disease,  or  a  surgeon  repairing  an  injury,  occult  influences  fre- 
quently play  a  most  important  part.  Professor  Elwell  in  his 
work  on  Malpractice,  etc.,  p.  25,  lays  great  stress  on  this 
element  of  uncertainty.  He  says :  "  In  the  case  of  physicians, 
surgeons,  attorneys,  etc.,  another  and  important  element  besides 
skill  enters  into  the  result,  and  for  this  reason  the  degree  of 
responsibility  is  to  a  certain  extent  and  in  a  manner  indicated 
and  influenced.  This  important  element  is  the  operation  of 
causes  and  influences  over  which  the  practitioner  has  but  little 
or  no  control.  They  are  occult,  and  no  human  foresight  is  able 
to  anticipate  them  before  they  have  completely  deranged  and 
materially  interfered  with  his  plans  by  bringing  about  a  different 
result  than  that  confidently  depended  upon."  ' 

Change  cmd  Advancement  in  Medical  Knoivledge  also  to 
be  Considered. — It  should  on  the  other  hand  be  clearly  under- 
stood that  the  constant  change  and  improvement  which  are  go- 
ing on  in  medical  and  surgical  education,  in  the  discovery  of 
new  remedies  and  new  methods  of  treatment,  and  in  the  inven- 
tion of  new  instruments,  tend  constantly  to  elevate  the  average 
skill  and  intelligence  of  the  profession,  and  with  them  the  stand- 
ard by  which  the  courts  will  determine  liability  for  negligence. 
"What  would  have  been,  but  a  few  years  ago,  fully  recognized 
\)j  the  courts  as  ordinary  skill  in  the  treatment  of  disease  and  the 
performance  of  operations,  would  now  be  regarded  as  antiquated 
and  less  than  ordinary  skill,  because  of  the  advancement  in 
the  knowle(Jge  of  means  which  can  be  devoted  to  the  treatment 
of  disease  and  injury.* 

We  have  already  seen  that  what  is  the  degree  of  skill  to  be 
required  of  one  practising  in  a  small  town  or  a  country  district 
sparsely  inhabited,  and  what  is  required  in  the  case  of  a  city 
practitioner,  may  differ  to  some  extent  with  the  circumstances. 
Quacks  and  pretenders,  however,  must  be  judged  by  the  stand- 
ard of  regular  practitioners.^ 

^  See  Corsi  v.  Maretzek,  4  E.  D.  professing  to  treat  patients  as  a 
Smith,  1,  quoted  at  p.  362  of  this  clairvoyant  must  be  held  to  the 
volume.  standard  of  regular  practising  phy- 

^ Small'?).  Howard,  128 Mass. ,  131,  sicians  in  the  neighborhood  where 
and  cases  cited.  the  clairvoyant   operates.      Nelson 

^  Clairvoyancy  of  course  is  not  v. '  Harrington,  72  Wis. ,  591  ;  Bib- 
recognized  in  the  courts  as  medical  ber^.  Simpson,  59  Me.,  181  ;  Musser 
or  surgical  practice.     And  any  one      v.  Chase,  29  Ohio  St. ,  577. 


DEGREE  OF  CARE  AND  SKILL.  S3 

Degree  of  Care  and  Skill  a  Mixed  Question  of  Law 
and  Fact. — What  constitutes  reasonable  care  and  skill  is  a 
mixed  question  of  law  and  fact,  like  any  other  question  of 
negligence.  Where  the  evidence  is  undisputed  and  no  conflict- 
ing inferences  can  be  drawn  from  the  facts  presented,  it  is  the 
duty  of  the  Court  to  determine  whether  or  not  there  is  sufficient 
proof  of  want  of  ordinary  care  and  skill  to  be  submitted  to 
the  jury.  Where,  however,  the  evidence  is  conflicting  on  that 
point,  or  the  inferences  to  be  drawn  from  the  facts  established 
might  be  differently  drawn  by  different  men  having  the  same 
opportunity  for  observation,  and  the  same  circumstances  before 
tbem,  it  is  for  the  jury  to  say  whether  or  not  the  defendant  has 
exercised  reasonable  care  and  skill,  guided  by  proper  directions 
from  the  Court  as  to  the  measure  of  skill  required.  This  in- 
volves the  question  as  to  how  far  the  practitioner  is  bound  to  be 
familiar  with  the  methods,  appliances,  drugs,  and  methods  of 
treatment  of  his  profession  in  general." 

Experimentation  Not  Permissible. — Experimentation, 
whether  upon  charity  patients  or  paj^  patients,  is  equally  pro- 
hibited by  well-settled  rules  of  law.  In  other  words,  a  depar- 
ture from  known  methods  of  treatment  for  the  purpose  of  or  by 
way  of  trjdng  unknown  remedies,  or  operations  not  usually 
adopted  by  the  profession,  if  an  unfortunate  result  occurs, 
renders  the  defendant  liable  (McNevins  v.  Lowe,  40  111.,  209). 

Measure  op  Damages. 

The  measure  of  damages  in  cases  of  malpractice  may  vary 
with  the  kind  of  malpractice.  In  the  case  of  wilful  malpractice, 
the  element  of  gross  negligence  justifies  punitive  or  retaliatory 
damages,  in  those  States  where  any  such  damages  are  allowed. 
That  is,  damages  which  will  not  only  compensate  for  the  inju- 
ries inflicted,  but  which  will,  by  pvuiishing  the  wrong  done, 
tend  to  repress  similar  acts  in  the  future.  The  tendency  of  the 
courts  and  of  legal  authority  of  the  present  time  is,  however, 
to  limit  as  often  as  possible  the  cases  in  which  punitive  dam- 
ages are  allowed,  upon  the  theory  that  if  a  grossly  negligent  act 
is  committed  it  will  require  criminal  prosecution,  and  that  the 

1  McCandless  v.  McWha,  22  Pa.  St. ,  261 ;   Carpenter  v.  Blake,  supra : 
Leighton  v.  Sargent,  supra. 


S^l  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

strong  arm  of  the  State  should  be  invoked  to  punish  the  wrong, 
rather  than  to  line  the  pocket  of  the  injured  person. 

On  the  other  hand,  in  cases  of  malpractice,  damages  for 
want  of  ordinary  care  and  skill  are  recompensed  as  in  any  other 
cases  of  negligence.  They  may  include  loss  of  time  of  the 
patient,  inability  to  earn  his  living,  such  sum  as  the  jury  thinks 
is  reasonable  to  be  given  as  a  compensation  for  the  extra  pain 
and  suffering,  and,  where  the  injury  is  permanent,  such  further 
sum  as  will  indemnify  the  patient  for  the  injury  or  deformity 
which  he  may  suffer  on  account  of  the  defendant's  neglect. 
Citation  of  authority  upon  this  question  of  damages  is  almost 
unnecessar5^ ' 

Liabilities  of  Partners,  etc. — It  has  been  held  that  where 
two  physicians  were  partners,  and  one  of  them  committed  an 
act  of  negligent  malpractice,  both  were  liable  in  a  civil  court 
for  damages.'' 

But  the  declarations  of  the  partner  who  is  guilty  of  the 
negligent  act,  made  as  to  the  act  committed,  and  in  the  absence 
of  the  other  partner,  are  not  admissible  as  against  the  other 
partner.  And  so  also  is  the  rule  as  to  declarations  of  the 
partner  who  committed  the  act  after  its  commission  as  to  the 
propriety  of  the  treatment,  and  opinions  expressed  by  him  in 
reference  thereto.' 

It  has  also  been  held  that  one  surgeon  who  recommends  the 
employment  of  another  during  his  absence  from  town  is  not 
liable  for  acts  committed  during  his  absence." 

Suits  for  Injuries  to  Married  Women  and  Minor 
Children. — When  the  person  injured  is  a  married  woman,  her 
husband  may  sue  for  loss  of  services  on  account  of  malpractice, 
and  when  the  injured  person  is  a  minor  child  the  parent  may 
sue  as  in  any  case  of  negligence.  A  third  person,  such  as  the 
husband  of  a  woman  injured  by  malpractice,  or  the  father  of 
minor  child  so  injured,  can  only  recover  the  value  of  the  ser- 
vices thereby  lost,  and  in  some  cases  the  enhanced  expense  of 
medical  attention  and  nursing  thereby  rendered  necessary. 

'Kelley  v.    Hay,    84   Ind.,     189;  ^ Hyrne -y.  Irwin,  23  S.  Car.,  226, 

Stone -y.  Evans,  32  Minn. ,  243;  Teft  s.  c. ,   55  Am.  Rep.,   15;  Whittaker 

V.  Wilcox,  6Kans.,  646;  Brookes.  v.  Collins.  34  Minn.,  209. 

Clark,     57   Tex..    105;    Graunis    V.  »  Boor  n.  Lowrev,  103  Ind.,  468. 

Branden,  5  Day  (Conn.),  260,  s.  c,  5  *  Hitchcock  v.  Burgett,  38  Mich., 

Am.  Dec,  143  :  Wenger  v.  Calder,78  501. 
111. ,  275  ;  Carpenter  v.  Blake,  snpra. 


INSPECTION   OF   THE    INJURED    PERSON.  85 

Inspection  of  the  Injured  Person  at  the  Trial — 
Before  Trial  Improper. ^ — In  an  action  in  wiiich  the  injury  is 
to  a  portion  of  the  body  which  may  be  seen,  such  as  the  shorten- 
ing of  a  limb  on  account  of  improper  treatment  of  a  fracture, 
the  limb  may  be  exhibited  to  the  jury. 

It  has  been  much  discussed  whether  the  defendant  in  a  mal- 
practice or  other  negligence  case  can  compel  the  plaintiff  to 
permit  his  person  to  be  examined  by  j^hysicians  before  trial,  to 
enable  the  defendant  to  know  the  full  extent  of  the  injur)-  so 
far  as  it  is  perceptible.  In  the  latest  cases  the  examination 
of  plaintiff  before  trial  was  not  allowed. ' 

In  1877  the  Supreme  Court  of  Iowa  in  the  case  of  Schroder 
V.  C,  R.  I.  &  P.  R.  R.  Co.,  47  Iowa,  375,  held  that  the  court 
had  inherent  power  and  jurisdiction  to  compel  the  plaintiff  to 
submit  to  such  an  examination. 

This  decision  has  been  followed  by  the  courts  of  several  of  the 
western  and  southern  States,  while  in  others  the  power  has  been 
denied.  These  cases  will  be  found  fully  collected  in  Roberts  t\ 
O.  &  L.  C.  R.  Co.  and  in  U.  P.  R.  R.  Co.  v.  Botsford  cited  above. 

The  ground  of  the  decision  of  the  United  States  Supreme 
Court  and  of  the  New  York  Court  of  Appeals  seems  to  be,  that 
in  the  absence  of  legislative  provision  permitting  a  court  to 
order  such  an  examination,  it  has  no  inherent  power  to  do  so, 
and  did  not  derive  any  such  powers  from  the  common-law 
courts  of  England,  which  never  had  exercised  such  powers. 

In  some  of  the  cases  which  denj-  the  right  to  comj^el  such 
examination,  it  is  claimed  that  if  such  a  statute  was  passed  as 
would  confer  upon  the  courts  power  to  compel  such  an  exami- 
nation, the  statute  would  be  unconstitutional,  and  much  is  said 
in  those  decisions  about  the  sacredness  and  immunity  of  the 
person.  It  seems  difficult,  however,  to  understand  why  such 
statutes  should  be  considered  as  differing  in  any  respect  from 
statutes  permitting  orders  for  the  examination  of  witnesses  and 
parties  before  trial,  or  for  the  discovery  and  inspection  of  books 
and  papers,  and  the  like,  which  statutes  have  been  enacted  for 
many  years  and  have  never  been  held  to  be  unconstitutional. 
Surely  an  honest  suitor  having  a  just  claim  for  damages  for 

iSeeU.  P.  R.  R.  Co.  v.  Botsford,      Roberts  v.  O.  &  L.  C.   R.  Co.,  29 
141  U.  S.,  350;   McQuiggan  ?■.  D.,      Hun,  154,  aud  cases  cited. 
L.  &  W.  R.   R.  Co.,  129  N.  Y..  50; 


86  LEGAL   STATUS   OF   PHYSICIANS — BECKER. 

personal  injuries  would  not  object  to  such  an  examination,  be- 
cause the  result  would  often  strengthen  his  case,  while  a  dis- 
honest suitor  having  a  false  and  unmeritorious  claim  ought 
to  be  exposed  and  have  his  false  claims  defeated,  in  the  inter- 
ests of  justice  and  truth.  On  the  other  hand,  a  suitor  who  was 
honestly  mistaken  in  his  belief  that  he  had  been  disfigured  or 
injured  by  an  act  of  malpractice  might  often  discover  his  mis- 
take, and  be  saved  the  annoyance  and  expense  of  defeat  after 
a  trial  in  open  court. 

Some  of  the  most  frequent  cases  of  alleged  malpractice, 
brought  before  the  courts,  are  those  in  which  it  is  claimed  that 
a  fractured  limb  has  been  improperly  set,  with  the  result  that 
it  becomes  crooked  or  shortened ;  when  the  fact  is,  as  is  con- 
clusively shown  by  Prof.  Frank  H.  Hamilton  in  a  paper  pub- 
lished by  him  many  years  ago,  and  quoted  with  approval  by 
Professor  Elwell,  in  his  work  on  Malpractice,  etc.,  that  the 
percentage  of  cases,  in  certain  kinds  of  fractures,  in  which  per- 
fect results  are  obtained  by  even  the  most  eminent  surgeons, 
is  very  small.  In  such  cases  as  these  the  true  state  of  affairs 
might  often  be  disclosed  by  careful  inspection  prior  to  the  trial. 
On  the  whole  more  good  than  harm  would  seem  to  be  the 
probable  outcome  of  permitting  such  examinations,  in  mal- 
practice cases,  if  not  in  all  cases  of  alleged  personal  injuries. 

Evidence  in  Malpractice  Cases. — The  prevailing  trial 
practice  in  malpractice  cases  is  to  prove  the  condition  of  the 
patient  prior  to  the  employment  of  defendant  and  at  the  time 
the  treatment  in  question  began,  the  methods  of  treatment 
adopted,  and  instructions  given,  and  the  condition  of  the  patient 
during  and  after  such  treatment,  and  then  to  place  other  phy- 
sicians on  the  witness-stand,  and  put  to  them  hypothetical 
questions  involving  the  facts  as  established  by  the  evidence, 
and  calling  upon  them  to  state  whether  the  method  of  treat- 
ment adopted  indicated  proper  skill  and  care,  or  even  the  usual 
and  recognized  methods  of  the  profession.' 

In  some  States  evidence  of  the  general  reputation  of  the  de- 
fendant for  skilfulness  or  the  contrary  is  held  admissible.  In 
other  States  such  evidence  is  held  inadmissible  (see  Vol.  XIV., 
Am.  and  Eng.  Encyclopaedia  of  Law,  p.  83,  and  cases  collected 
in  Note  6) . 

'  Olmstead  v.  Gere,  100  Pa.  St. ,  127  ;  Carpenter  v.  Blake,  supra. 


EVIDENCE — CONTRIBUTORY   NEGLIGENCE.  87 

Contributory  Negligence. — In  conclusion  it  should  be 
stated  that  the  patient  is  bound  to  follow  obediently  all  proper 
directions  given  him  by  his  physician  or  surgeon,  as  to  his 
diet,  mode  of  life,  time  of  taking  and  quantity  of  medicine  to 
be  taken,  or  the  care  of  a  diseased  or  injured  member.  Any 
disobedience  of  such  directions  which  contributes  to  prevent 
a  recovery  will  bar  him  from  his  right  of  action  for  malprac- 
tice, even  though  the  medical  man  may  have  been  somewhat 
negligent.  In  short,  the  same  rule  as  to  contributory  negligence 
applies  in  this  as, in  any  other  case  of  negligence.  This  prin- 
ciple has  been  so  long  and  so  well  settled  that  citation  of  author- 
ity in  support  of  it  is  unnecessary. 


THE  LAW  OF  EVIDEISTOE 


CONCERNING 


CONFIDENTIAL   COMMUNICATIONS 


BETWEEN 


PHYSICIAN  AND  PATIENT. 


BY 

chari.es  a.  boston, 

CounseUor-at-Laic,  of  the  New  York  City  Bar. 


co:^fidei^tial  commu^icatiol^s 
betwee:^  physicia]^  and 

PATIEl^T. 

PRIVILEGED  COMMUNICATIONS. 

Confidential  communications  between  physician  and 
patient  not  infrequently  may  relate  to  matters  that  are  the  sub- 
jects of  inquiry  before  judicial  tribunals.  When  these  com- 
munications are  by  law  excluded  from  disclosure  in  evidence, 
they  are  termed  privileged  communications.  When  such  a 
disclosure  is  forbidden  it  is  upon  grounds  of  public  policy/ 
"  because  greater  mischiefs  would  probably  result  from  requir- 
ing or  permitting  its  admission,  than  from  wholly  rejecting  it." 

COMMON  LAW. 

The  common  law  required  an  inviolable  secrecy  to  be  ob- 
served by  attorneys  with  reference  to  the  communications 
which  they  had  received  from  their  clients.^  But  writers  upon 
the  law  of  evidence  state  that  under  the  English  rule  protection 
from  disclosure  in  evidence  in  a  court  of  justice  was  not  extended 
to  communications  between  a  medical  man  and  his  patient.^ 

Reasons  for  the  Rule. — It  does  not  clearly  appear,  in  any 
of  the  cases  usually  cited  as  authority,  why  the  distinction  is 

'  Greenleaf  Ev. ,    s.    236  ;    Taylor  ^  The   successive  efforts  made  to 

Ev. ,  s.  908  ;  Bouvier's  Law  Diction-  extend  protection  by  judicial    rul- 

ary,  p.  363 ;  Am.  and  Eng.  Enc.  of  ing    to     communications    between 

Law,  vol.  19,  p.  122;  Code  Civ.  Pro.  physician  and  patient  will  appear 

Cal. ,  s.    1,881;  Mills'  Ann.  Stats,  of  from  a  consideration   of  the  cases 

Col.,     1891,  s.    4,824;    Rev.    Stats.  that  are  usually  cited  as  authority 

Idaho,   1887,  s.   5,958;    Gen.   Stats.  for  the  English  rule:    Annesley  v. 

Minn.,  1891,  s.  5,094;  Comp.  Stats.  Earl  of  Anglesea    (1743),    18  How. 

Mont.,  1887,  s.  650;  Gen.  Laws  Ore.,  St.    Tr.,    1,139;    Duchess  of  King- 

1892,    s.    712;    Comp.    Laws  Utah.  ston's  case  (1776),  20  How.  St.  Tr., 

1888,  s.  3,877.  355    (cf.    p.    572,   p.   585,   p.   586,   p. 

•^TavlorEv.,s.  911;  Stephen,  Dig.  613);    Wilson  r-.   Rastall    (1791),    4 

of  Ev.',    art.    115;  Greenleaf  Ev.,  s.  Term  R.    (Durnford   &  East),    753: 

237.  Rex  v.  Gibbous  (1823),   1  C.  &  P., 


92 


CONFIDENTIAL   COMMUNICATIONS — BOSTON. 


made  between  legal  and  medical  advisers,  but  it  is  apparent 
that  the  privilege  does  not  rest  upon  considerations  of  honor  nor 
of  confidence/  nor  even  upon  the  urgency  of  the  situation  under 
which  the  communication  is  made ;  for  disclosures  are  made  to 
a  physician  frequently  to  save  life,  or  to  a  priest  for  reasons  of 
eternal  import,  while  those  made  to  an  attorney  insure  at  most 
protection  from  temporal  annoyance.  The  privilege  of  attor- 
neys seems  to  be  founded  upon  considerations  of  public  policy 
in  the  administration  of  justice  in  the  courts;  attorneys  are  a 
part  of  the  sj^stem,  as  are  grand  jurors,  petit  jurors,  and  judges," 
and  even  arbitrators ;  ^  but  physicians  are  no  part  of  that  system, 
and  ■  a  disclosure  of  confidences  made  to  them  in  no  way  tends 
to  weaken  the  system  or  render  it  ineffectual,  while  the  compul- 

97 ;  Broad  v.  Pitt  (1828),  3  C.  &  P. , 
518 ;  Greenough  v.  Gaskell  (1833),  1 
My.  &  K. ,  98.  See  also  Wheeler  v.  Le 
Marchant,  50  L.  J.  Ch.,  795  (1880). 

1  Phillips  Ev.,  p.  136;  Starkie 
Ev.,  p.  40;  Wharton  Ev.,  s.  606; 
Greenleaf  Ev.,  sees.  248,  237,  239; 
Taylor  Ev.,  s.  916;  Stephen,  Dig. 
of  Ev.,  art.  115;  Rogers'  Expert 
Testimony,  s.  45 ;  Reynolds'  Theory 
of  Evidence,  s.  86. 

It  is  to  be  noted  that  none  of  the 
cases  which  ai'e  cited  as  authority 
for  the  common-law  rule  as  usually 
stated  are  really  precedents  to  that 
extent.  The  cases  of  the  Duchess  of 
Kingston  (siqjra)  ;  Lord  William 
Russel  (9  How.  St.  Tr. ,  603)  ;  Dr. 
Ratcliff  (9  How.  St.  Tr. ,  583) ;  Earl 
Ferrers  (19  How.  St.  Tr. ,  886) ,  and 
Rex  V.  Gibbons  {siqwa),  were  all 
criminal  prosecutions  ;  and  in  An- 
nesley  v.  Anglesea,  Wilson  v.  Ras- 
tall.  Broad  v.  Pitt,  and  Greenough 
V.  Gaskell  (supra),  which  were  civil 
causes,  the  question  of  the  privilege 
of  a  medical  man  was  not  really  in 
dispute.  It  is  well  settled  that 
communications  between  attorney 
and  client  are  privileged,  and  yet 
Judge  Pitt  Taylor  expresses  some 
doubt  whether  the  protection  can- 
not be  removed  without  the  client's 
consent  in  cases  where  the  interests 
of  criminal  justice  require  the  pro- 
duction of  the  evidence  (Taylor  Ev. , 
s.  939).  This  intimation  of  a  dis- 
tinction between  criminal  and  civil 
actions,  even  in  the  case  of  attor- 
neys,  suggests  the  possibility  of  a 


difference  between  those  two  classes 
of  actions  in  the  case  of  medical 
men.  The  cases  cited  establish  au- 
thoritatively that  in  criminal  pros- 
ecutions, at  common  law,  confi- 
dential communications  between 
medical  man  and  patient  are  not 
privileged ;  but  in  civil  causes,  the 
opinions  of  the  eminent  judges 
seem  to  be  obiter  dicta.  It  is,  how- 
ever, established  by  other  decisions 
that  mere  confidential  relations  do 
not  prevent  the  disclosure  of  com- 
munications. (For  the  case  of  hatik- 
ers,  see  Loyd  v.  Freshfield,  2  C.  & 
P. ,  335 ;  managers,  Anderson  v. 
British  Bank  of  Columbia.  45  L.  J. 
Ch.,  449;  clerks,  Lee  v.  Burrell,  3 
Camp. ,  337 ;  Webb  v.  Smith,  1  C.  & 
P. ,  337  ;  stewards,  Vaillant  v.  Dode- 
mead,  2  Atk.,  524;  Earl  of  Fal- 
mouth V.  Moss,  11  Price,  455;  Pur- 
suivant of  Herald's  College,  Slade 
V.  Tucker,  49  L.  J.  Ch.,  644.) 

The  opinions  of  so  many  eminent 
men,  though  strictly  speaking  obiter 
dicta,  together  with  the  uniform 
statements  of  text- writers  based 
upon  them,  leave  no  room  for  reason- 
able doubt  tnat  independent  of  stat- 
ute, in  civil  as  well  as  criminal 
causes,  communications  between 
medical  adviser  and  patient  are  not 
entitled  to  protection  from  disclos- 
ure in  evidence. 

'See  Duchess  of  Kingston's  case 
(supra,  p.  91,  note  3)  (cf.  ib.,  pp. 
573.  585,  586,  613).  [253a. 

-Greenleaf   Ev.,    sees.    249,     352, 

3  Greenleaf  Ey.    s.  249. 


THE   RULE   IN   THE   UNITED    STATES.  93 

sory  examination  of  lawyers  would  tend  to  the  suppression  of 
the  truth  in  litigation  by  discouraging  confidence  between  at- 
torney and  client.  This,  perhaps,  can  be  assigned  as  the  reason 
for  the  distinction;  a  distinction  which  does  not  differentiate 
lawyers  from  physicians,  but  agents  in  the  administration  of 
justice  from  all  others.' 

Criticism  of  the  Rule. — Though  the  privilege  of  attorneys 
was  adopted  to  enforce  respect  for  the  law  as  securing  the  rights 
of  persons  entitled  to  its  protection,  by  establishing  inviolable 
confidence  between  them  and  the  officer  who  represents  them  in 
their  dealings  in  the  law,  and  though  it  was  not  the  purpose  of 
the  law  to  enforce  sentiment  or  to  elevate  one  profession  above 
another,  the  sentimental  idea  did  not  suffer  neglect  for  the  want 
of  advocates.  Justice  Buller  lamented  the  narrowness  of  the 
rule,'^  and  Mr.  Best  has  criticised  it  as  harsh  in  itself,  of  ques- 
tionable policy,  and  at  variance  with  the  practice  in  France  and 
the  statute  law  in  some  of  the  United  States  of  America.' 


THE  RULE  IN  THE  UNITED  STATES. 

It  is  to  be  assumed,  in  the  absence  of  statutes  varj-ing  the 
rule,  and  of  decisions  to  the  contrary,  in  the  several  States  of 
the  United  States,  that  in  those  States  which  derived  their  law 
from  England  the  same  rule  of  evidence  obtains  as  that  above 
enunciated.  But  many  of  the  legislatures  have  bj^  statute  ex- 
tended the  privilege  to  communications  between  physicians  and 
their  patients,  as  well  as  to  other  specified  confidential  commu- 
nications which  it  does  not  fall  within  the  scope  of  this  work  to 
discuss.* 

'See  Barnes  v.    Harris,  7Cush. ,  a  statutory  privilege  for  commiini- 

576 ;   Hatton  v.   Robinson,  4  Pick,  cations  between  physician  and  pa- 

432.     See  also  historical  review  of  tient,    tliat  "  in  4  Term  Eep. ,    oWO, 

the  attorney's  privilege  and  the  rea-  Buller,  J.   (to  whom  no  one  will  at- 

sons  for  it,  by  Judge  Seldon,  at  Spe-  tribute  a   disposition  to  relax   the 

cial  Term,  in  Rochester  City  Bank  rulesof  evidence) ,  said  it  was  'much 

V.  Suydam,  5  How.  Pr.  (N.Y.),  254.  to  be  lamented'  that  the   iuforma- 

^  Wilson  V.    Rastall,    4  Term  R.,  tion  specified  in  this  section  (2  R. 

753.  S. ,  p.  406,  s.  73)  was  not  privileged. 

^  Best,  Prin.  of  Ev. .  s.  582.  Mr.    Phillips    expressed    the    same 

•*The  revisers  of  the   New  York  sentiments  in  his  treatise  on  Evi- 

Statutes  in  1828  in  their  report  (5  dence.  p.  104.    The  ground  on  which 

N.  Y.    Stats,    at  Large,    edited  bj^  communications  to  cojf/ise/ are  priv- 

John  W.  Edmonds,  2d  ed.,  p.   726)  ileged   is  the  supposed  necessity  of 

stated  as  their  reason  for  suggesting  a  full  knowledge  of  the  facts,  to  ad- 


^4 


CONFIDENTIAL   COMMUNICATIONS — BOSTON. 


States  and  Territories  in  u'hich  there  are  No  Restric- 
tive Statutes. — The  following  States  and  Territories  have  no 
statute  restricting  the  nature  of  the  disclosures  which  a  physi- 
cian may  be  compelled  to  make  in  a  court  of  justice :  Alabama, 
Arizona,  Connecticut,  Delaware,  District  of  Columbia,  Florida, 
Georgia,  Illinois,  Kentuck}-,  Louisiana,  Maine,  Marj^land,  Mas- 
sachusetts, Mississippi,  New  Hampshire,  New  Jerse}',  New 
Mexico,  Pennsylvania,  Rhode  Island,  South  Carolina,  Tennes- 
see, Texas,  Vermont,  Virginia,  and  West  Virginia. ' 

States  and  Territories  in  ivliich  there  are  Restrictive 
Statutes. — The  following  States  and  Territories  have  statutes 
restricting  disclosures  by  physicians :  Arkansas,  California, 
Colorado,  Idaho,  Indiana,  Indian  Territory,  Iowa,  Kansas, 
Michigan,  Minnesota,  Missouri,  Montana,  Nebraska,  Nevada, 
New  York,  North  Carolina,  North  Dakota,  Ohio,  Oklahoma, 
Oregon,  South  Dakota,  Utah,  Washington,  Wisconsin,  and 
Wyoming. '^ 


vise  correctly,  and  to ,  prepare  for 
the  proper  defence  or  prosecution  of 
a  suit.  But  surely  the  necessity  of 
consulting  a  medical  adviser,  when 
life  itself  may  be  in  jeopardj%  is  still 
stronger.  And  unless  such  consulta- 
tions are  privileged,  men  will  be  in- 
cidentally punished  by  being  obliged 
to  suffer  the  consequences  of  injuries 
w^ithout  relief  from  the  medical  art, 
and  without  conviction  of  any  of- 
fence. Besides,  in  such  cases,  dur- 
ing the  struggle  between  legal  duty 
on  the  one  hand  and  professional 
honor  on  the  other,  the  latter,  aided 
by  a  strong  sense  of  the  injustice  and 
inhumanity  of  the  rule,  will  inmost 
cases  furnish  a  temptation  to  the 
perversion  or  concealment  of  truth, 
too  strong  for  human  resistance.  In 
every  view  that  may  be  taken  of 
the  policy,  justice  or  humanity  of 
the  rule  as  it  exists,  its  relaxation 
seems  highly  expedient. " 

These  or  similar  reasons  have  pre- 
vailed in  many  States  and  Territo- 
ries to  bring  about  a  statutory  re- 
striction on  disclosures. 

'  The  following  cases  show  or  tend 
to  show  that  the  English  rule  is  in 
operation  in  Connecticut,  Maine, 
Maryland,  Massachusetts,  New  Jer- 
sey, Texas,  and  West  Virginia  :  Wil- 
son v.  Town  of  Granby,  47  Conn., 


59  ;  Fayette  v.  Chesterville,  77  Me. , 
28  ;  Weems  v.  Weems,  19  Md. ,  334  ; 
Morrissey  V.  Ingham,  111  Mass.,  63; 
Barber  v.  Merriam,  11  Allen,  332 ; 
Castner  v.  Sliker,  4  Vr. ,  95 ;  Stea- 
gald  V.  State,  3S.W.  Rep.,  771 ;  Jar- 
rett  t'.  Jarrett,  llW.Va.,  584.  For 
the  common-law  rule  in  the  States 
where  statutes  are  now  in  force,  see 
Campau  v.  North,  39  Mich.,  606; 
Territory  v.  Corbett,  3  Mont. ,  50  ; 
Pierson  r.  People,  79  N.  Y. ,  424 ; 
Edington  v.  JEtna  L.  I.  Co. ,  77  N. 
Y. ,  564  ;  Buffalo  Loan  Tr.  &  S.  D. 
Co.  V.  Knights  Templar,  etc.,  126 
N.  Y.,  450. 

2  Dig.  Stats.  Ark.,  1884,  s.  2,862; 
Code  Civ.  Pro.  Cal. ,  s.  1, 881  as  amend- 
ed Law  1893,  c.  217;  Mills'  Ann. 
Stats.  Col.,  1891,  sees.  4,824,  4,825; 
R.  S.  Ida.,  1887,  s.  5,958;  Myers' 
Ann.  R.  S.  Ind. ,  1888,  s.  497 ;  Act 
of  May  2d,  1890,  U.S.  Stats,  at  Large, 
c.  182,  making  the  laws  of  evidence 
of  Arkansas  applicable  to  Indian 
Territory ;  McClain's  Ann.  Code 
Iowa,  1888,  s.  4, 893  ;  Code  Civ.  Pro. 
Kan. ,  s.  323  ;  Gen.  Stats.  Kan. ,  1889, 
s.  4,418;  Howell's  Ann.  Stats.  Mich., 
1882,  s.  7,516;  Kellev's  Gen.  Stats. 
Minn.,  1891,  s.  5,094;  R.  S.  Mo., 
1889,  s.  8, 925  ;  Comp.  Stats.  Mont. , 
1887,  s.  650  ;  Code  of  Civ.  Pro.  Neb. , 
sees.  333,  334;  Bailey  &  Hammond's 


THE   STATUTES.  95 

The  Rule  in  United  States  Courts. — In  trials  at  com- 
mon law  in  the  courts  of  the  United  States,  the  laws  of  the 
several  States,  except  where  the  Constitution,  treaties,  or  statutes 
of  the  United  States  otherwise  require  or  provide,  are  regarded 
as  rules  of  decision,'  Section  858  of  the  Revised  Statutes  of 
the  United  States  prescribes  rules  with  reference  to  competency 
notwithstanding  color  and  interest  of  witnesses,  and  in  actions 
by  or  against  executors,  administrators,  or  guardians,  and  then 
provides  that "  in  all  other  respects  the  laws  of  the  State  in  which 
the  court  is  held  shall  be  the  rules  of  decision  as  to  the  compe- 
tency of  witnesses  in  the  courts  of  the  United  States  in  trials 
at  common  law,  and  in  equity  and  admiralty."  Accordingly 
it  has  been  held  by  the  Supreme  Court  of  the  United  States 
that  in  an  action  in  the  Circuit  Court  of  the  United  States  for 
the  Southern  District  of  New  York,  on  a  policy  of  life  insur- 
ance, the  evidence  of  a  phj'sician,  inadmissible  under  Section 
834  of  the  New  York  Code  of  Civil  Procedure,  was  properly  ex- 
cluded.'' But  in  criminal  prosecutions  in  United  States  Courts, 
the  privilege  secured  by  State  statutes  does  not  avail.' 

THE  STATUTES. 

As  the  effect  of  these  statutes  depends  largely  upon  their 
language,  the  construction  put  upon  the  law  in  one  State  is 
chiefly  serviceable  in  interpreting  that  of  another  State  in  those 
particulars  where  the  two  are  similar. 

Statutory  Declarations  of  Policy. — A  comparative  view 
of  the  several  laws  shows  that  in  the  following  States  and  Ter- 
ritory there  are  declarations  of  policy  prefixed  to  the  prohibition 

Gen.   Stats.    Nev.,    1885,    s.    3,406;  and  the  date  of  the  i^assage  of  tho 

Code  Civ.  Pro.  N.Y.,  sees.  834,836,  as  earlier   of  these  laws,  see  note  to 

amended  by  Laws  1893,  c.  295;  Laws  Gartside  v.  Connecticut  Mutual  L. 

of  N.C.Actof  1885,c.  159;  Code  Civ.  I.  Co.,  76  Mo.,  446. 

Pro.    Dak.,    1883,   s.   499;  Smith  &  '  Rev.  Stats.  U.  S.,  s.  721. 

Benedict'sR.S.  Ohio,  1890.  s.  5,241;  ^  Conn.     Mut.    Life    Ins.    Co.    r. 

Stats,  of  Okl.,  1893,  s.  4,213;  Hill's  Union  Trust  Co.,    112  U.    S.,  250. 

Gen.  Laws  Ore.,  1892,  sees.  712,  713;  See  also  Dreier  v.  Continental  L.  I. 

Code  Civ.  Pro.   Dak.,  1883.  s.  499;  Co.,  24  Fed.  Rep.,  670;  Adrereuo  r. 

Code  Civ.  Pro. Utah,  s.  1, 156  ;  Comp.  Mutual  Res.  Fund  L.  I.  Co.,  34  Fed. 

Laws  of  Utah,  s.  3,877  ;  2  Hill's  Ann.  Rep.,  870. 

Stats. Wash.,  1891,  s.  1,649  :  Sanborn  =' Logan  v.  United  States,  144  U. 

&   Berryman's   Ann.    Stats.    Wis.,  S.,  263:  United  States  v.   Raid,    12 

1889,  s.  4,075;  R.  S.  Wyo.,  1887,  s.  How.,  361. 
2, 589.     For  the  chronological  order 


96  CONFIDENTIAL  COMMUNICATIONS — BOSTON. 

of  disclosures,  that  show  the  reason  of  the  enactment,  namely : 
California,  Colorado,  Idaho,  Minnesota,  Montana,  North  Da- 
kota, Oregon,  South  Dakota,  and  Utah/  The  declaration  is  to 
the  effect  that  there  are  particular  relations  in  which  it  is  the 
policy  of  the  law  to  encourage  confidence  and  to  preserve  it  in- 
violate, and  that  therefore  the  prohibition  of  the  statute  is  laid. 

Analysis  of  the  Statutes. 

The  common  purpose  of  the  statutes  is  to  restrict  the  rule 
compelling  disclosures  so  as  to  protect  communications  with 
a  physician  in  his  professional  capacity;  but  the  limit  to 
which  the  protection  is  extended  differs  in  the  various  States. 
An  analytic  comparison  of  the  statutes  tends  to  show  how  far 
the  interpretation  of  one  is  useful  in  construing  another. 

I.  Nature  of  the  Exclusion. — In  Calif  ornia,  Idaho,  Minne- 
sota, Montana,  North  Dakota,  Oregon,  South  Dakota,  Utah, 
and  Washington  the  statutes  apply  only  to  testimony  in  civil 
actions.''  The  other  statutes  make  no  distinction  between  civil 
and  criminal  proceedings. 

The  active  words  are  of  course  different  in  the  several  stat- 
utes, but  they  indicate  a  purpose  to  extend  a  privilege  that  the 
person  entitled  to  it  may  insist  upon  maintaining,  with  the  sin- 
gle exception  of  the  law  of  North  Carolina,  which  provides  that 
the  presiding  judge  of  a  superior  court  may  compel  a  disclos- 
ure, if  in  his  opinion  the  same  is  necessary  to  a  proper  adminis- 
tration of  justice. 

Some  of  the  statutes  show  clearly  that  it  is  the  patient's 
privilege,  and  suffer  the  patient  or  his  representatives  to  waive 
it,  either  expressly  or  by  conduct  which  the  law  declares  to 
amount  to  a  waiver.'     Others  are  silent  on  this  subject. 

In  California,  Colorado,  Idaho,  Iowa,  Minnesota,  Montana, 
Nebraska,  Nevada,  New  York,  North  Dakota,  Ohio,  Oregon, 
South  Dakota,  Utah,  Washington,  and  Wyoming,  it  is  expressly 
provided  that  the  patient's  consent  is  necessary  before  a  dis- 
closure will  be  permitted. 

'  See  references  to  the  several  ^  This  seems  to  be  the  proper  con- 
statutes  in  note  2  on  p.  94.  struction  of  the  Kansas  and  Okla- 

-  See  Freelf.  Market  St.  Cable  Ry.  homa  statutes,  though  what    seem 

Co.,   31  Pac.   Rep.,    730  (Supr.    Ct.  to  be   typographical  errors  in  the 

Cal.) .  published  laws  render  it  doubtful. 


ANALYSIS   OF   THE   STATUTES.  97 

In  Colorado,  Kansas,  Oklahoma,  and  Oregon,  if  the  patient 
offer  himself  or  a  physician  or  surgeon  as  a  witness,  that  is  to 
be  deemed  a  consent. 

In  Nevada,  in  anj''  suit  or  prosecution  for  malpractice,  if  the 
patient  or  party  suing  or  prosecuting  shall  require  or  give  con- 
sent, and  any  physician  or  surgeon  shall  give  testimony,  then 
the  defendant  may  call  any  other  physicians  or  surgeons  as  wit- 
nesses without  the  consent  of  the  patient  or  party  suing  or  pros- 
ecuting. 

In  Ohio  and  Wyoming,  if  the  patient  voluntarily  testify  the 
physician  may  be  compelled  to  testify  on  the  same  subject. 

II.  The  Witness. — In  Indiana,  Ohio,  and  Wyoming  the 
privileged  witness  is  termed  a  jjhysicianj  in  the  other  States 
and  Territories,  the  privilege  extends  to  s.  physician  ov  surgeon. 

In  Arkansas  and  Indian  Territory  the  privilege  is  secured  to 
a  person  authorized  to  XDractise  physic  or  surgery;  in  Califor- 
nia, Montana,  and  Nevada,  to  a  licensed  physician  or  surgeon; 
in  Colorado,  to  a  physician  or  surgeon  duly  authorized  to  prac- 
tise his  profession  under  the  laivs  of  the  State;  in  Michigan, 
New  York,  North  Carolina,  and  Wisconsin,  to  a  person  duly 
authorized  to  practise  physic  or  surgery;  in  Minnesota,  Ore- 
gon, and  Washington,  to  a  regidai^  physician  or  surgeon ;  in 
Iowa  and  Nebraska,  to  a  practising  physician  or  surgeon ;  in 
the  remaining  States  and  Territories,  these  statutes  do  not  in 
terms  distinguish  between  licensed  and  unlicensed  practitioners. ' 

In  New  York,  by  the  amendment  of  1893  to  Sec.  836  of  the 
Code  of  Civil  Procedure  it  is  provided  that  in  an  action  for  the 
recovery  of  damages  for  a  personal  injury  the  testimony  of  a 
physician  or  surgeon  attached  to  any  hospital,  dispensary,  or 
other  charitable  institution,  as  to  information  which  he  acquired 
in  attending  a  patient  in  a  professional  capacitj'  in  such  insti- 
tution, shall  be  taken  before  a  referee.  It  does  not  appear 
whether  this  amendment  is  intended  to  take  away  the  privilege, 
or  merely  to  regulate  the  manner  of  taking  such  testimony  when 
it  is  otherwise  admissible.'' 

III.  The  Evidence. — The  character  of  the  communications 
which  are  privileged  differs  under  the  several  statutes.     In  Ar- 

'  For  laws  regulating  practice  in  °  Laws  N.  Y.,  Act  1893,  c.  295. 

the  several   States   and  Territories, 
see  infra,  p.  137  et  seq. 

7 


98  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

kansas,  California,  Colorado,  Idaho,  Indian  Territory,  Michi- 
gan, Minnesota,  Missouri,  Montana,  Nevada,  New  York,  North 
Carolina,  North  Dakota,  Oregon,  South  Dakota,  Utah,  Wash- 
ington, and  Wisconsin,  they  are  characterized  as  information; 
in  Indiana,  as  matte?'  committed;  in  Iowa  and  Nebraska,  as 
confidential  communications;  in  Kansas,  Ohio,  Oklahoma,  and 
Wyoming,  as  communications;  in  Iowa  and  Nebraska,  it  is 
further  provided  that  they  beproper/?/  intrusted;  and  in  Kansas 
and  Oklahoma,  that  they  be  with  reference  to  a  physical  or 
supposed  physical  disease. 

In  Kansas  and  Oklahoma,  any  knowledge  obtained  by  a  per- 
sonal examination  of  a  patient  is  also  expressly  privileged. 

In  Indiana,  Ohio,  and  Wyoming,  advice  given  by  the  phy- 
sician is  covered  by  the  protection. 

In  Arkansas,  Indian  Territory,  and  Missouri,  the  privilege 
is  limited  to  information  acquired  from  the  patient;  and  in 
Kansas  and  Oklahoma,  to  communications  made  hy  the  patient. 

The  statutes  of  Arkansas,  California,  Colorado,  Idaho,  In- 
dian Territory,  Indiana,  Michigan,  Minnesota,  Missouri,  Mon- 
tana, Nevada,  New  York,  North  Carolina,  North  Dakota,  Ore- 
gon, South  Dakota,  Utah,  Washington,  and  Wisconsin  expressly 
limit  the  protection  to  matter  acquired  while  attending  in  a 
professional  capacity ;  and  all  of  these,  save  Indiana,  as  well  as 
Iowa  and  Nebraska,  confine  the  privilege  to  information  neces- 
sary to  enable  the  witness  to  prescribe  or  act  for  the  patient. 

In  Ne"v\j  York  it  is  provided  that  "  a  physician  or  surgeon 
may  upon  a  trial  or  examination  disclose  any  information  as  to 
the  mental  or  physical  condition  of  a  patient  who  is  deceased, 
which  he  acquired  in  attending  such  patient  professionally, 
except  confidential  communications  and  such  facts  as  would 
tend  to  disgrace  the  memory  of  the  patient,  when  the  protection 
has  been  expressly  waived  on  such  trial  or  examination  by  the 
personal  representatives  of  the  deceased  patient,  or  if  the  valid- 
ity of  the  last  will  and  testament  of  such  deceased  patient  is  in 
question,  by  the  executor  or  executors  named  in  said  will,  or 
the  surviving  husband,  widow,  or  any  heir  at  law,  or  anj"  of  the 
next  of  kin  of  such  deceased,  or  any  other  party  in  interest."  * 

IN.  Y.  Code  Civ.  Pro.,  s.  S36,  as      1891,  c.   381,  and  modified  by   Act 
amended  Act  1893,  c.  295.   A  similar      1892,  c.  514. 
exception  was    introduced  by  Act 


JUDICIAL   INTERPRETATION   OF   THE   STATUTES.  'JU 

The  notable  characteristics  of  the  several  statutes  which  thus 
far  have  been  pointed  out  are  discernible  in  the  express  lan- 
guage of  the  acts.  In  writing  or  using  any  treatise  or  compi- 
lation on  privileged  communications  between  physician  and 
patient,  it  is  to  be  constantly  borne  in  mind  that  the  privilege 
is  of  statutory  origin;  that  the  statutes  are  often  dissimilar; 
and  that  the  value  of  a  judicial  interpretation  of  one  law  in  the 
construction  of  another  varies  with  the  dissimilarity. 

JUDICIAL  INTERPRETATION  OF  THE   STATUTES. 

The  judicial  decisions  which  are  discussed  here  are  those 
that  deal  with  the  privilege  secured  b}^  the  restrictive  laws. 
The  analogy  between  the  privilege  of  a  client  with  regard  to  his 
attorney's  disclosures,  and  that  of  a  patient  with  regard  to  the 
testimony  of  his  physician,  is  not  so  complete  as  to  make  it  es- 
sential to  present  here,  for  the  sake  of  their  bearing  upon  the 
subject  now  under  consideration,  a  study  of  the  principles  to  be 
deduced  from  the  numerous  decisions  with  reference  to  attorne3'S 
as  witnesses.  The  analogous  cases  of  clergymen  and  priests 
are  also  bej'ond  the  scope  of  this  treatment. 

Rules  of  Construction. — The  restrictions  are  in  derogation 
of  the  common  law '  and  in  accordance  with  the  rule  of  inter- 
pretation ordinarily  adopted  should  be  strictly  construed, "^  but 
the  courts  have  generally  looked  at  the  policj'  of  the  enactments, 
and  have  construed  them  so  as  to  preserve  inviolably  the  con- 
fidence existing  between  physician  and  patient,  without  nar- 
rowing their  effect  to  a  strict  interpretation  of  their  language. 

In  Indiana,  under  a  former  law  which  protected  matters  con- 
fided, it  was  said  that  the  statute  should  be  given  a  broader 
scope  than  the  word  confided  in  a  strict  sense  imports,  so  as  to 
cover  matters  learned  by  observation  and  examination. °  But, 
though  the  statute  in  terms  absolutely  prohibits  a  disclosure,  it 
has  been  said,  in  Indiana,  that  it  gives  no  right  to  the  physi- 
cian to  refuse  to  testify  where  the  patient  waives  the  privilege,  * 

^  Supra,  p.  94,  note  1.  Beck,    77  Ind.,    203.     For  the  con- 

'  Bishop,  Written  Laws,  sees.  119,  structiou  of  particular  words  and 

155;  Potter's  Dwarris,  Statutes,  p.  phrases,  see  infra,  p.  115  et  seq. 

185;  1   Bouvier's  Law  Dictionary.  •*  For  waiver  of  the  privilege,  see 

"Construction."  p.  386.                    '  infra,  p.  106. 
^Masonic    Mut.     Ben.     Assn.     v. 


100  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

and  that  it  creates  no  absolute  incompetency,  because  to  hold 
otherwise  would  result  in  obstructing  justice  without  subserv- 
ing the  purpose  of  the  statute.'  In  Missouri,  there  is  a  dictum 
that  the  privilege  should  be  carefully  limited  to  what  the  stat- 
ute requires,  not  so  much  because  it  is  in  derogation  of  the 
common  law  as  because  it  is  in  exclusion  of  the  best  evidence, 
on  the  ground  of  privilege ;  °  but  in  this  very  case,  the  real  ques- 
tion was  whether  the  word  oral  should  be  construed  into  the 
statute  so  as  to  exclude  from  its  protection  information  acquired 
by  inspection  and  observation,  and  it  was  held  that  no  such 
narrow  interpretation  was  proper.  In  a  later  case  the  narrow- 
ing dicta  of  the  foregoing  opinion  were  disapproved,^  and  sub- 
sequently the  disposition  to  make  a  liberal  construction  was 
shown  by  the  highest  court  of  the  State,  although  a  general  rule 
of  interpretation  was  not  announced.^  In  New  York,  the  rule 
that  a  statute  in  derogation  of  the  common  law  is  strictly  con- 
strued does  not  apply  to  the  Code  of  Civil  Procedure.*  But 
before  the  enactment  of  this  statutory  rule "  there  was  a  ten- 
dency to  interpret  liberally  the  law  prohibiting  disclosures.'' 
In  Arkansas  the  tendency  seems  to  be  to  construe  the  law 
strictly.'  The  spirit  of  interpretation  will  be  more  fully  illus- 
trated in  the  discussion  of  particular  cases  which  follows. 

In  New  York  it  was  claimed  that  the  protection  afforded  by 
the  statute  is  nullified  by  the  provision  for  the  examination  of 
a  party  before  trial,*  but  it  was  held  that  the  statutes  are  con- 

1  Penn  Mut.   L.  I.   Co.  v.  Wiler,  N.   Y. ,  185.     Cf .   Kendall  v.  Grey. 

100  Ind. ,  92.  2  Hilt. ,  300  ;   Pearsall  v.   Elmer,   5 

^  Lunz  V.  Mass.  Mut.  L.  I.  Co.,   8  Redf. ,  181.     A  disposition  to   con- 
Mo.  App. ,  363.  strue  the  statute  strictly  was   dis- 

^  Kling  V.  City  of  Kansas,  27  Mo.  closed  in  the  opinion  of  Earl,  J. ,  in 

App.,  231.  Edington  v.  ^tna  L.  I.  Co.,  77  N. 

"•Gartside  V.  Conn.  Mut.  L.  I.  Co.,  Y. ,  564,  but  his  personal  views  were 

76  Mo. ,  446  ;    said  to  be  overruled  disapproved  in  subsequent  cases  ;  see 

byGrollv.  Tower,  85  Mo.,  249,   in  Grattan  v.   Metro.  L.   I.  Co.,  80  N. 

Squires  v.    City  of  Chillicothe,   89  Y. ,  281  ;  Renihan  v.  Dennin,  103  N. 

Mo.,  226;  but  followed  in  Thomp-  Y.,    573;  Buffalo  Loan,  etc.,  Co.  v. 

son  V.  Ish,  99  Mo. ,  160.  Knights  Templar,  etc. ,  126  N.  Y. , 

*  N.  Y.  Code  Civ.  Pro. ,  s.    3, 345.  450.     See  also  Jones  v.    Brooklyn, 

Disclosures  by    physicians    are  re-  etc. ,  Ry.  Co. ,  3  N.  Y.  Supp. ,  253 ; 

stricted    by  sees.    834,   836  of   said  in  matter  of  Darragh,  52  Hun,  591  ; 

Code.  Marx   v.    Manhattan    Ry.    Co.,    56 

^  Code  Civ.  Pro.,  sees.  834,  836,  as  Hun,    575;    Treanor  v.    Manhattan 

new  existing  are  re-enactments  with  Ry.  Co.,  28  Abb.  N.  C. ,  47. 

modifications  of  2  R.  S. ,  p.  406,  s.  73.  « See  Collins  v.  Mack,  31  Ark. ,  684. 

'  People  V.  Stout,  3  Park  Cr.  Rep. ,  ^  N.  Y.  Code  of  Pro. ,  s.  390  ;  N.  Y. 

670 ;  Edington  v.  Mut.  L.  I.  Co.,  67  Code  of  Civ.  Pro.,  s.  870. 


CLASSES   OF   ACTIONS.  101 

sistent  and  the  physician  cannot  be  made  to  disclose,  though 
his  patient  may  be.' 

Classes  of  Actions. 

Crhninal  Actions  and  Evidence  of  Crime  in  Civil 
Actions. — The  statutes  confining  the  restriction  to  civil  actions 
have  been  cited  above.  ^  In  Iowa,  in  an  action  for  breach  of 
promise  to  marry,  it  was  said  that  the  privilege  does  not  ex- 
tend to  the  protection  of  advice  for  the  commission  of  a 
crime,'  In  New  York  the  rule  was  at  first  embodied  in  the 
Revised  Statutes  of  the  State,*  but  upon  the  adoption  of  the 
Code  of  Civil  Procedure  it  was  included  therein,  ^  and  subse- 
quently the  provision  of  the  Revised  Statutes  was  repealed."  In 
that  State  by  law  the  rules  of  evidence  in  civil  cases  are  appli- 
cable also  to  criminal  cases,  except  as  otherwise  expressly  pro- 
vided;'' and  the  statutes  provide  no  different  rule  in  criminal 
actions  as  to  this  class  of  evidence.  Notwithstanding  this  fact, 
however,  it  has  been  said  by  the  Court  of  Appeals,  in  a  case 
where  there  was  an  attempt  to  screen  a  murderer  by  insisting 
that  his  victim's  physician  was  not  a  competent  witness  as  to 
information  acquired  by  him  while  attending  his  patient,"*  that 
the  design  of  the  law  was  to  enable  the  patient  to  make  known  his 
condition  to  his  physician  without  the  danger  of  disclosing  what 
would  annoy  his  feelings,  damage  his  character,  or  impair  his 
standing  while  living,  or  disgrace  his  memory  when  dead,  but 
that  it  was  not  intended  to  protect  a  murderer  rather  than  to 
shield  his  victim;  and  quoting  from  the  opinion  of  Talcott,  J., 
in  the  court  below,  ^  the  Court  said :  "  The  purpose  for  which  the 
aid  of  the  statute  is  invoked  is  so  utterly  foreign  to  the  purpose 
and  object  of  the  act  and  so  diametrically  opposed  to  any  intent 

'Edington  v.  Mut.    L.  I.   Co.,    5  4  2R.  S.,  406,  s.  73. 

Hun,  1  ;  s.  c,  67  N.  Y.,  185.  *  Act  1876,  c.  448,  Code  Civ.  Pro., 

Under  sec.   873,  Code  Civ.  Pro. ,  sees.  834,  836. 
as  amended  by  Law  1893,  c.  721,  the  « Act  1877,  c.  417,  s.  1. 

plaintiff  in  an  action  for  personal  '  3  R.  S.,  1029,  s.  19.     Superseded 

injuries  may  be  compelled  to  sub-  by    Code    Crim.    Pro.,    s.    392,     as 

mit  to  a  physician's  inspection.    Cf.  amended  by  Act  1892,  c.   279,  s.  7. 

Packer.  Page,  51  Mich.,  88.  People  v.  Murphy,  101   N.  Y.,  126. 

^  Siqjva,  p.  96.  People  v.  Brower,  53  Hun,  217. 

^  Guptill  V.  Verback,  58  Iowa,  98.  »  Pierson  r.  People,  79  N.  Y. ,  424 ; 

In  this  case,  however,  it  was  deter-  People  7-.  Harris,  136  N.  Y.,  423. 
mined  that  it  did  not  appear  that  a  **  Pierson  v.  People,  18  Hun.  239. 

crime  was  intended. 


102  CONFIDENTIAL  COMMUNICATIONS — BOSTON. 

which  the  legislature  can  be  supposed  to  have  had  in  enacting 
it,  so  contrary  to  and  inconsistent  with  its  spirit,  which  most 
clearly  intended  to  protect  the  patient  and  not  to  shield  one  who 
is  charged  with  his  murder ;  that  in  such  a  case  the  statute  is 
not  to  be  so  construed  as  to  be  used  as  a  weapon  of  defence  to  a 
party  so  charged  instead  of  a  protection  to  his  victim."  Ac- 
cordingly it  was  held  that  the  evidence  was  not  to  be  excluded 
under  the  statute.  But  the  rule  is  still  applicable  to  criminal 
actions.  In  a  later  case,  where  the  accused  was  indicted  for 
abortion,  the  same  court  held,  that  where  the  patient  was  living 
and  the  disclosure  tended  to  convict  her  too  of  crime  or  to  cast 
discredit  and  disgrace  upon  her,  the  evidence  of  her  physician 
as  to  information  acquired  by  him  in  attendance  upon  her  was 
inadmissible  in  the  trial  of  the  man  charged  with  the  crime.' 
In  a  still  later  case,^  the  General  Term  of  the  Supreme  Court 
held,  where  the  accused  was  on  trial  for  murder  and  he  had 
confided  to  a  physician  what  he  had  done,  that  the  physician 
could  not  disclose  the  confidence.  The  rule  deducible  from  these 
decisions  seems  to  be  that  in  New  York  the  privilege  extends 
to  criminal  actions,  even  though  they  be  trials  for  murder,  and 
even  though  the  person  accused  be  the  patient,  but  that  the 
statute  will  be  applied  only  for  the  protection  of  the  patient,  and 
where  it  is  apparent  that  no  injury  can  possibly  be  done  to  the 
patient  or  his  memory  by  the  admission  of  the  evidence,  and  the 
interests  of  justice  demand  the  disclosure,  for  the  punishment 
of  a  person  for  an  injury  done  to  the  patient  involving  a  viola- 
tion of  the  criminal  law,  and  the  patient  is  not  alive  to  waive 
the  privilege,  that  the  disclosure  is  not  forbidden. 

In  New  York  efforts  have  been  made  to  exclude  from  the 
operation  of  the  statute  other  classes  of  actions,  to  which  it  has 
been  urged  that  the  reasons  for  the  enactment  do  not  apply,  or 
in  which  the  mischief  alleged  to  be  wrought  by  its  enforcement 
has  been  suggested  as  ground  for  believing  that  the  legislature 
could  not  have  intended  to  include  them.  Of  these,  actions  for 
divorce  on  the  ground  of  adultery  are  one  class ;  but  it  has  been 
held  that  they  constitute  no  exception.' 

'People  V.   Murphy,    101    N.   Y. ,  ^Johnson    t'.    Johnson,    4   Paige, 

126  (1886).  460:  s.  p.,  14  Wend.,  636;  Hanford 

■'  People  V.  Brower,    53  Hun,  217  v.  Hanford,  3  Edw.  Ch. ,  468  ;  Hunn 

(1889) .     See  also  People  v.  Stout,  8  v.  Hunn.  1  T.  &  C,  499. 

Park  Cr.  Rep. ,  670.  In    Indiana,     information   as    to 


CLASSES   OF   ACTIONS.  103 

Testamentary  Causes. — In  New  York  it  was  long  sup- 
posed that  the  policy  of  the  law  excepted  probate  proceedings ; 
it  was  so  held  by  the  Surrogate  of  New  York  City ; '  and  also 
by  the  General  Term  of  the  Supreme  Court/  by  which  it  was 
stated  that  the  practice  had  prevailed  for  a  half-century  in  will 
cases/  but  the  Court  of  Appeals/  has  decided  that  testamen- 
tary cases  constitute  no  exception  to  the  rule,  the  judge  who 
delivered  the  opinion  stating  that  there  is  no  more  reason  for 
allowing  secret  ailments  cf  a  patient  to  be  brought  to  light  in 
a  contest  over  his  will  than  in  any  other  case,  and  that  if  mis- 
chief be  wrought  by  the  law  the  remedy  lies  with  the  legislature 
and  not  with  the  courts.  The  legislature  has  since  afforded 
the  remedy,  ^  but  not  to  the  extent  of  adopting  the  rule  of  the 
earlier  cases.  In  Indiana,  in  an  action  to  set  aside  a  will,  the 
testimony  of  the  testator's  physician  has  been  excluded.*  And 
in  Michigan  and  Missouri  it  seems  that  testamentary  cases  are 
no  exception  to  the  general  rule.' 

Lunacy  and  Habitual  Drunkenness. — It  has  been 
claimed  in  New  York  that  inquisitions  of  lunacy  are  an  excep- 
tion, and  recently  it  has  been  held  that  the  alleged  lunatic's 
physician  may  testify  as  to  his  mental  condition  because  no  one 
is  better  qualified  to  testify,*  but  this  decision  seems  to  be  at 

abortion  and  criminal  intimacy  is  (Supr.  Ct.,  G.  T.,  1887).     In  matter 

protected  in  an  action  for  criminal  of  Connor  (Sup.  Ct.,  G.  T.),  27  N.  Y. 

conversation.     Harris  v.  Rupel,  14  St.  Rep.,  905  (1889)  ;  Mason  v.  Wil- 

Ind.,  209.     In  Hewitt  v.   Prime,  21  liams  (Sup.  Ct.,  G.  T.,  1889),  6N.Y. 

Wend.,  77  N.  Y.  (1839),   in  an    ac-  Supp.,479;  Van  Or  man  v.  Van  Or- 

tion  for  seduction  the  testimony  of  man  (Sup.  Ct.,  G.T.,  1890),  34N.Y. 

a  physician  that  he  was  asked  for  St.  Rep.,  824.     See  also  In  matter  of 

medicine  to   produce    an    abortion  Halsey  (N.  Y.  Suit.),  29  N.  Y.  St. 

was  admitted.     It  was  stated  that  Rep.,    533    (1890).     Allen  v.    Pub. 

such  testimony  is  not   privileged,  Adm.,  1  Bradf.,  221,  had  been  over- 

but  there  were  other  reasons  for  the  ruled  in  part  by  Edington  v.  Mut. 

judgment,  and  the  case  seems  to  be  L.  I.  Co.,  67  N.  Y.,  185  (1876),  but 

at  variance  with  later  decisions  on  not  on  this  point, 
that  principle.  *  Supra,  p.  98. 

See    also     Briggs  v.    Briggs,    20  "Heuston  t\  Simpson,  115  Ind., 62. 

Mich.,  34.  ■"  Fraser  r>.   Jennison,    42    Mich., 

'  Allen  t).  Pub.   Adm.,  1  Bradf.,  206.     In  this  case  the  testimony  was 

221  (1850).  admitted  on  the  ground  that  the  rep- 

'^  Staunton  v.  Parker,   19  Hun,  55  resentative   could  waive  the  privi- 

(1879) .  lege.     See  Thompson  r.  Ish,  99  Mo. , 

^  Citing  the  fact  that  no  objection  160. 
was  raised  in  the  noted  case  of  Dela-  **  In   re    Benson   (Monroe   County 

field  r.  Parish,  25  N.  Y.,  1.  Court),   16  N.  Y.  Supp.,  Ill  (1891). 

^Renihan  v.  Dennin,   103  N.  Y. ,  Some  States  have  statutory  provi- 

573   (1886),    followed    in  Loder    v.  sions  for  the  qualification  of  physi- 

Whelpley.  Ill  N.  Y. ,  239  (1888).    In  ciaus  as  examiners  in  lunacy,  e.g.. 

re  Hannah,  11  N.  Y.    St.  Rep.,  807  Laws  of  Col.,    1893,    c.    119,  s.   5; 


104  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

variance  with  the  principle  of  the  decisions  of  the  Court  of 
Appeals  with  reference  to  testamentary  cases,  and  presents  no 
satisfactory  reason  for  a  distinction.  In  a  similar  case  in  the 
Supreme  Court,  Chambers,  it  was  held  that  a  medical  attendant 
at  an  asylum  could  not  testify.'  It  has  also  been  held  that  a 
physician  cannot  make  an  affidavit  as  to  the  appearance  and 
condition  of  his  patient  to  support  a  petition  for  the  appoint- 
ment of  a  committee  for  him  as  an  habitual  drunkard.'' 

Fraud. — Still  another  class  of  actions  in  which  contend- 
ing principles  have  been  invoked  to  make  an  exception  in  the 
law  of  privilege,  is  actions  on  life-insurance  contracts.  The 
contract  of  insurance  is  uberrimcB  fidei,  and  the  defence  of 
fraud  in  the  application  is  frequently  interposed  to  defeat  a 
claim  under  a  policy.  Medical  testimony  would  often  be  the 
most  satisfactory  evidence  to  establish  the  fraud,  and  efforts  have 
been  made  to  introduce  it  under  that  excuse,  but  without  avail. 
In  the  case  of  Dilleber  vs.  Home  Life  Insurance  Company,  in 
the  Supreme  Court  of  New  York  at  General  Term,  ^  the  question 
seems  to  have  been  directly  before  the  court,  and  Davis,  P.  J., 
dissenting,  insisted  that  the  suppression  of  a  physician's  testi- 
mony ought  not  to  be  permitted  so  as  to  cover  up  a  fraud,  but  the 
majority  of  the  court  held  otherwise ;  the  case  was  subsequently 
overruled,  but  not  on  the  ground  urged  b}^  Justice  Davis.  ^ 
The  number  of  insurance  cases  in  which  the  rule  has  been 
enforced  seems  to  leave  it  bej'ond  question  that  it  will  not  be 
relaxed  for  the  purpose  of  establishing  fraud,  ^  although  that 
announcement  has  not  been  specifically  made.  There  seems  no 
reason  that  the  rule  should  be  relaxed  in  that  regard  when  it  is 
not  relaxed  to  establish  the  crime  of  the  patient ;  though  the 
mischief  that  may  be  done  in  such  cases  is  apparent." 

Laws  of  N.  Y.,  1874,   c.  446,   t.    1,  77  Ind.,    203;    Excelsior  Mut.   Aid 

art.  1,   s.  1.     The  bearing  of  these  Assn.    v.   Riddle,  91  Ind.,  84;  Penn 

provisions  upon  the  statutory  priv-  Mut.  L.   I.  Co.  v.  Wiler,   100  Ind., 

ilege  has  not  been  made  clear.  92  ;  ^tna  L.  I.  Co.  v.  Denning.  123 

iln  matter  of  Baird,    11   N.   Y.  Ind.,  390 ;  Lunz  v.  Mass.  Mut.  L.  I. 

State  Rep.,  263(1887).  Co.,  8  Mo.   App.,   363;  Edington  u. 

2  In  matter  of  Hoyt,  20  Abb.  N.  Mut.  L.I. Co.,  67N.Y.,  185;  Grattan 

C.  (Sup.  Ct.,  G.  T.,  1887).  v.  Metrop.  L.  I.  Co.,  80  N.  Y.,  281  ; 

M3  N.  Y.  W.  D.,  505  (1880).  s.  p.,  93N.  Y.,  274  ;  Conn.  Mut.  L.  I. 

•*Dilleber  v.  Home  L.  L  Co.,    13  Co.  v.  Union  Tr.  Co..  112 U.  S.,  250. 

N.  Y.  W.  D.,  505  (1881).  «See  Renihan  v.  Dennin,   103  N. 

^  The  following  cases  in  which  the  Y..  573,  dictum  to  same  effect, 

rule  has  been  enfoi-ced  have  arisen  As  to  whether  a   physician  may 

out  of  contracts  of  life  insurance :  contradict    his  patient   to   prevent 

Masonic  Mut.  Ben.  Assn.  v.  Beck,  fraud,  see  infra,  p.  Ill  et  seq. 


THE   WITNESS.  105 

The  Witness. — The  statutory  provisions  as  to  the  profes- 
sional status  of  the  witness  whose  testimony  is  exchided  have 
ah'eady  been  shown/  The  facts  which  establish  the  relation 
of  physician  and  patient  will  be  treated  later.*  The  witness  is 
a  member  of  a  profession,  but  there  is  very  little  discussion  in 
the  cases  as  to  what  constitutes  a  physician  or  surgeon.^  The 
language  of  the  statutes  as  well  as  their  policy  and  intent  has 
been  said  to  plainl}"  embrace  a  physician  who  casuall}"  or  in  any 
way  attends  and  prescribes  for  a  patient,  whether  he  be  a  family 
physician  or  the  usual  medical  attendant  or  not.''  The  spirit 
of  the  acts  would  protect  communications  made  to  any  person 
attending  the  patient  in  the  accepted  capacitj^  of  physician  or 
surgeon  wherever  that  might  have  happened,  though  the  letter 
would  confine  it  in  some  instances  to  duly  authorized  or  duly 
licensed  persons.  It  does  not  seem  to  have  been  established 
whether  such  authority  or  license  must  have  been  granted  under 
the  laws  of  the  State  where  the  trial  is  conducted,  nor  how  the 
several  statutes  apply  to  communications  made  elsewhere,  es- 
pecially in  States  or  countries  where  authority  or  license  to  prac- 
tise is  not  required  by  law. 

It  has  been  said  with  reference  to  the  New  York  law  that  it 
is  absolutely  necessary  that  the  witness  should  be  a  duly  qual- 
ified physician ;  ^  and  it  has  been  held  that  the  words  "  duly 
authorized  "  mean  those  persons  who  are  not  prohibited  by  the 
penal  code  from  practising,  so  that  an  unlicensed  physician  may 
be  compelled  to  disclose  confidential  communications. "  Whether 
the  same  rule  would  be  applied  with  reference  to  information 
obtained  in  another  State  by  a.  physician  duly  authorized  to 
practise  there  although  prohibited  from  practising  in  New  York, 

'  Supra,  p.  97.  •*  Edington  v.  Mutual  L.  I.  Co. ,  5 

2  Infra,  p.  119.  Hun,  1. 

3  "  Physician  :  A  person  wlio  has  ^  People  v.  Stout,  3  Park  Cr. 
received  the  degree  of  doctor  of  Rep.,  670  (1858).  In  this  case  the 
medicine  from  an  incorporated  in-  witness  was  undoubted!}-  a  duly 
stitution  ;  one  lawfully  engaged  in  qualified  physician  under  the  State 
the  practice    of    medicine." — Bou-  law. 

vier'sLaw  Diet.,  vol.  ii.,  p.  412.  «  Wiel    v.    Cowles,    45  Huu,    307 

"Surgeon:   One  who  applies  the  (1887)  (Supreme  Ct.,  Gen.  T.) .    Sec. 

principles  of  the  healing  art  to  ex-  356,  N.  Y.  Penal  Code,  which  was 

ternal  diseases  or  injuries,  or  to  in-  in  0])eration  at  that  finite,  was  re- 

ternal   injuries   or    malformations.  pealed  by  Act  1887,  c.  647,  s.  9.  but 

requiring   manual   or  instrumental  the     prohibition    of     unauthorized 

intervention.     One    who    practises  practice  is  now  to  be  found  in  Act 

surgery."— Bou vier's     Law     Diet.,  1893,  c.  661,  s.  140. 
vol.  ii',  p.  698,  q.  v. 


106  CONFIDENTIAL   COMMUNICATJONS — BOSTON. 

is  a  question  that  is  suggested  as  a  case  within  the  reason  of  the 
law  but  outside  of  its  letter,  and  one  which  does  not  seem  to 
have  been  answered. 

In  New  York,  in  an  action  by  a  physician  for  compensation 
for  his  services,  it  was  held  that  a  person  who  merely  answered 
for  a  physician  at  his  office  in  his  absence,  and  was  not  himself 
a  physician,  is  not  a  witness  whose  testimony  is  privileged.' 

In  Missouri  it  has  been  held  that  a  drug  and  prescription 
clerk  is  not  a  privileged  witness.^  The  question  arose  in  the 
same  State,  whether  a  dental  surgeon  is  forbidden  to  testify 
under  the  statute,  but  its  determination  was  not  essential  to  the 
judgment  and  it  was  left  unanswered.^ 

To  establish  the  privilege  it  is  necessary  that  the  person  who 
insists  upon  it  to  exclude  testimony  should  show  by  competent 
evidence  that  the  witness  belongs  to  the  class  privileged  under 
the  law.^  But  where  the  physician  testified  that  he  was  a  reg- 
ular practising  physician  and  attended  in  that  capacity,  and 
he  was  not  examined  further  as  to  his  due  authority,  it  was  held 
that  a  failure  to  produce  his  license  could  not  be  urged  on  ap- 
peal as  reason  for  compelling  him  to  testify.^  The  Court  said 
that  if  the  privilege  were  the  physician's  he  might,  if  the  objec- 
tion were  taken,  be  required  to  prove  by  the  best  evidence  that 
he  was  duly  authorized,  but  as  it  is  the  patient's  privilege,  in  the 
absence  of  objection  to  the  sufficiency  of  the  proof,  the  patient 
is  entitled  to  the  benefit  of  the  presumption  that  the  physician 
had  the  license  which  the  law  requires  to  entitle  him  to  practise. 

Waiver  of  the  Privilege. 

Who  may  Waive. — Those  States  in  whicli  the  law  provides 
for  a  waiver  have  been  enumerated ; '  in  others  the  courts  have 
determined  that  the  privilege  of  waiving  is  implied  in  the  reason 
for  the  law.  In  Indiana  it  has  been  held  that  although  the  statute 
contains  in  terms  an  absolute  prohibition,  it  creates  no  absolute 
incompetency  and  the  privilege  may  be  waived  by  the  person  for 
whose  benefit  it  is  made  or  his  legal  representative. '     Under  the 

1  Kendall  v.  Gray,  2  Hilt. ,  300  (N.  =  Record  v.   Village  of  Saratoga 

Y.  Com.  PI.,  Gen.  T.,  1859).  Springs,  46  Hun,   448  (N.  Y.  Supr. 

»  Brown  v.  Hannibal  &  St.  J.  R.  Ct. ,  Gen.  T. ) . 

R.  Co. ,  66  Mo. ,  588.  e  Supra,  p.  96. 

^  Carrington  v.  St.  Louis,  89  Mo. ,  ''  Penn  Mut.   L.   I.   Co.   v.  Wiler, 

208.  100  Ind.,  92;  Morris  v.  Morris,  119 

*  Infra,  p.  128.  Ind.,  341. 


WAIVER   OF   THE   PRIVILEGE.  107 

Michigan  law  it  was  claimed  that  the  physician  is  forbidden  to 
reveal  confidences  even  though  he  have  his  patient's  consent, 
but  it  has  been  held  that  the  law  only  creates  a  privilege  on 
the  same  footing  with  other  privileged  communications,  which 
tlie  public  has  no  interest  in  suppressing  when  there  is  no  desire 
for  suppression  on  the  part  of  the  person  concerned.'  In  Mis- 
souri too  the  patient  may  waive  the  privilege." 

The  protection  vouchsafed  by  the  law  is  designed  for  the 
benefit  of  the  patient,  and  therefore  the  physician  himself  can- 
not waive  it.'  The  patient  can  disclose  his  own  physical  con- 
dition if  he  so  desires.^ 

But  the  physician  cannot  refuse  to  testify  if  the  patient 
waives  the  privilege.^ 

The  patient  can  waive  the  privilege  during  his  life." 

As  it  existed  prior  to  1891  the  New  York  law  provided  that 
the  prohibition  should  operate  unless  it  was  expressly  waived 
upon  the  trial  or  examination  by  the  patient.'  This  was  inter- 
preted to  mean  that  the  patient  himself  was  the  only  person  who 
could  make  a  waiver;  and  that,  therefore,  the  possibility  of 
waiver  ceased  with  the  death  of  the  patient,  while  the  privilege 
of  secrecy  continued  unabated,  so  that  those  claiming  under  the 
deceased  patient  could  not  waive  the  privilege,  nor  insist  upon 

'  Grand  Eapids  &  Ind.  R.  R.  Co.  *  Mulhado    v.    Brooklyn   City   R. 

V.  Martin,  41  Mich.,  667;  Fraser  v.  R.   Co.,    .-W  N.    Y.,    370;   Heller  v. 

Jennison,  43  Mich.,  206.  Sharon     Springs,      28     Hun,      344; 

-  Carrington  v.  St.  Louis,  89  Mo.,  Winner  v.  Lathrop,  67  Hun,  511. 

208  ;  Squires  v.  City  of  Chillicothe,  ^  SeePenn  Mut.  L.  I.  Co.  v.  Wiler, 

89  Mo.,  226  ;  Blair  v.  C.  &  A.  R.  R.  100  Ind..  93  ;  Territory  v.  Corbett,  3 

Co.,  89  Mo.,  334;  s.  p.,  89  Mo.,  383;  Mont.,  50;  Johnson  v.  Johnson,  14 

Adrereno  v.  Mut.  Res.  F.  L.  I.  Co.,  Wend.,  636;  Babcock  v.  People,   15 

34  Fed.    Rep.,    870;    Davenport  v.  Hun,  347. 

Citv  of   Hannibal,  18   S.  W.  Rep.,  «  Barton -y.  Allbright,  29 Ind.,  488 

1133.  Campau  v.    North,   39  Mich.,  606 

^  The  most  of  the  cases  in  which  Territory  i\  Corbett,  3  Mont. ,  50 
the  rule  has  been  enforced  are  those  Blair  t'.  Chic.  &  Alton  R.  R.  Co. ,  89 
in  which  the  physician  has  actually  Mo.,  334  ;  Johnson  v.  Johnson,  14 
testified  without  raising  the  objec-  Wend.  (N.  Y.),  636. 
tion  himself,  and  in  which,  there-  '  N.  Y.  Code  Civ.  Pro.,  s.  836 
fore,  the  rule  could  not  be  enforced  (Act  1876.  c.  448) ,  as  amended  Act 
if  the  physician's  waiver  were  valid,  1877,  c.  416,  s.  185.  Previous  to  the 
but  the  following  cases  particularly  Code  of  Civil  Procedure  the  pro- 
are  in  point :  Harris  tJ.  Rupel,  14  vision  for  waiver  was  not  in  the 
Ind. ,  209  ;  Barton  v.  Allbriglit,  29  statute,  3  R.  S. ,  406,  s.  73. 
Ind. ,  488 ;  Storrs  v.  Scougale,  48  The  amendment  of  1891  allowed 
Mich. ,  387  ;  Lunz  v.  Mass.  Mut.  L.  an  express  waiver  of  information, 
I.  Co.,  8 Mo.  App.,  363;  Johnson  v.  exce])t confidential  communications 
Johnson,  14  Wend.,  636;  Hanford  r.  and  su(;h  facts  as  would  tend  to  dis- 
Hanford,  3  Edw.  Ch.,  468;  People  grace  the  memory  of  tlie  patient,  by 
r.  Stout,  3  Park  Cr.  Rep. ,  670.  his  personal  representatives,   or   if 


108  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

the  testimony  of  the  physician,  even  though  their  interests  were 
in  jeopardy  on  account  of  his  silence. '  It  seems,  however,  that 
a  patient  can  during  his  hf etime  waive  the  privilege,  the  waiver 
to  take  effect  after  his  death.  ^  The  express  waiver  required  by 
the  statute  may  be  given  by  the  patient's  attorney,  because 
of  the  nature  of  the  attorney's  ageucj  in  conducting  an  action 
for  the  patient.^ 

None  of  the  other  statutes  are  in  the  exact  terms  of  the  New 
York  statute,  but  those  of  California,  Colorado,  Idaho,  Minne- 
sota, Montana,  Nevada,  North  Dakota,  Ohio,  Oregon,  South 
Dakota,  Utah,  Washington,  and  Wyoming  provide  that  the 
testimony  shall  not  be  given  unless  the  patient  consent;  in 
Iowa,  the  waiver  provided  for  is  that  of  the  person  in  whose 
favor  the  prohibition  is  made ;  and  in  Nebraska,  of  the  party 
in  whose  favor  the  provision  is  enacted. 

In  Indiana,  the  privilege  extends  beyond  the  death  of  the 
patient,  and  it  may  be  waived  bj"  the  party  who  inaj'  be  said  to 
stand  in  the  place  of  the  deceased  and  whose  interests  may  be 
affected  by  the  disclosure." 

In  Michigan,  what  the  patient  may  do  in  his  lifetime,  those 
who  represent  him  after  his  death  may  also  do  for  the  protec- 
tion of  the  interests  which  they  claim  under  him.^  In  Missouri 
the  representatives  of  the  patient  may  waive ; "  and  where  the 
dispute  is  between  devisees  and  heirs  at  law  all  claiming  under 
a  deceased  patient,  either  the  devisees  or  heirs  may  call  the  at- 
tending physician  of  the  testator  as  a  witness  regarding  infor- 
mation  acquired  by  him  in  his  professional   attendance.'     In 

the  validity  of  the  last  will  and  tes-  ^  See  In  matter  of  Freeman,  46 

tament  of  the  patient  is  in  question,  Hun,  548  (N.  Y.  Supr.  Ct. ,  G.  T. ,  1887) . 

by  the  executor  or  executors  named  See  Adrereno  i'.  Mut.  Ees.  F.  L. 

in  said  will.     Law  1891,  c.  381.  I.  Co.   (U.  S.  C.  C.  Mich.).  34  Fed. 

The  amendment   of    1892   added  Rep.,  870. 

the     surviving     husband,     widow,  ^  Alberti  v.  N.  Y. ,  L.  E.  &  W.  R. 

heir  at  law,  any  of  the  next  of  kin  R.  Co.,  118  N.  Y. ,  77. 

or  any  other  party  in  interest,   in  *  Masonic    Mut.    Ben.    Assn.     v. 

case  the  validity  of  the  last  will  and  Beck,  77  Ind. ,  203. 

testament  of  the  patient  is  in  ques-  *  Fraseri'.  Jennison,42Mich. ,  206. 

tion.     Law  1892.  c.  514.     The  pres-  «  Groll  r.  Tower,  85  Mo.,  249. 

ent  law  contains  the  same  provi-  ''Thompson  r.   Ish,   99  Mo.,    160, 

sions.     Act  1893,  c.  295.  distinguishes  the  New  York  statute 

'  Westover  v.  ^tna  L.  I.  Co. ,  99  from  the  Missouri  statute  ;  but 
N.  Y. ,  56;  Loder  v.  Whelpley,  111  seems  to  misinterpret  Heuston  v. 
N.  Y. ,  239  :  Alberti  v.  N.  Y. ,  L.  E.  «fe  Simpson,  115  Ind. ,  62.  which  does 
W.  R.  R.  Co.,  118 N.  Y. ,  77.  Staun-  not  hold  that  representatives  can- 
ton V.  Parker,  19  Hun,  55,  is  thus  not  waive,  but  that  they  can  invoke 
overruled.  protection. 


WAIVER   OF   THE   PRIVILEGE.  109 

Nevada  it  has  been  said  that  the  parents  of  a  seven-year-old 
infant,  may  waive  for  the  infant/ 

Objections  to  the  Admission  of  Privileged  Communica- 
tions; When  and  by  Whom  Made. — Having  considered  who 
can  waive  the  privilege,  it  is  material  to  discuss  also  the  ques- 
tion who  may  insist  upon  the  enforcement  of  the  law.  If  the 
protection  were  only  enforced  on  the  claim  of  privilege  by  the 
patient,  the  very  object  of  the  statutes  would  be  defeated  in 
the  large  majority  of  instances  because  of  the  absence  of  the 
patient  and  every  one  interested  in  his  behalf  to  assert  his  right. 
It  rests,  therefore,  with  any  party  to  raise  the  objection  and  as- 
sert the  prohibition.  But  it  seems  that  the  physician  himself, 
unless  a  party,  cannot  make  the  objection."  It  seems  to  have  been 
thought  in  some  of  the  cases  that  the  right  to  insist  upon  the  en- 
forcement of  the  law  is  coupled  with  an  interest  derived  from  the 
patient.  This  idea  started  from  the  language  used  in  the  early 
cases  enforcing  the  privilege  at  the  instance  of  those  claiming 
under  deceased  patients;^  and  it  led  to  some  confusion  where 
the  right  of  representatives  to  waive  the  privilege  was  denied ; 
but  it  seems  to  be  clear  that  the  right  to  object  differs  from  the 
right  to  waive  in  that  the  latter  is  necessarily  and  logically  de- 
pendent upon  the  relation  between  the  patient  and  his  representa- 
tive, while  the  former  is  obviously  suggested  as  the  best  method 
of  enforcing  the  law.  In  Indiana  it  has  been  said  that  the 
statute  gives  to  the  representative  of  a  deceased  patient  the  right 
to  object ; '  but  that  this  is  not  by  reason  of  the  relationship 
appears  from  another  case  in  the  same  State,  where  on  an  applica- 
tion for  anew  trial  the  Court  voluntarily  refused  to  grant  one 
for  newly  discovered  evidence  disclosed  to  it  by  a  physician's 
affidavit,  on  the  ground  that  if  the  patient  should  object  in  the 
new  trial  the  evidence  would  be  excluded.^  In  this  State  it  has 
been  held  that  the  widow  of  the  patient  cannot   object  to  the 

'  State  V.  Depoister,  25  Pac.  Rep.,  I.  Co.,  67  N.  Y.,  185;  see  Westover 

1000.  V.  ^tna  L.  I.    Co.,   99   N.  Y.,    56. 

-Johnson  v.  Johnson,  14  "Wond.,  Breisenmeister    v.      Supr.     Lod^e, 

636;   Babcock    v.    People,   15  Hun,  etc.,45N.  W.  Rep.,  977   (Supr.  Ct. 

347;  Valensin  v.  Valeusin,   14  Pac.  Mich.,  1890). 

Rep.,  87  (Supr.  Ct.  Cal.,   1887)  ;  cf.  •«  Penn  Mut.   L.   I.    Co.   r.  Wiler. 

In  re  Hannah,    11  N.  Y.  St.  Rep.,  100  Ind.,  92. 
807.  5  Harris  v.  Rupel,   14  Ind. ,     209. 

^  Penn  Mut.   L.   I.   Co.   f.  Wiler,  See  also  Carthage  T.  Co.  r.  Andrews., 

100  Ind.,  92;  Allen  r.   Pub.  Adm.,  1  N.  E.  Rep.,  364. 
1  Bradf . ,  221  ;  Edington  v.  Mut.  L. 


110  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

disclosure,  if  his  administrator  with  the  will  annexed  waives 
the  privilege.' 

In  Michigan  it  has  been  said  that  the  physician  cannot  avail 
himself  of  the  statute  for  his  own  benefit ;  but  that  was  in  a 
case  where  the  communication  was  not  really  of  the  privileged 
class.''  In  New  York,  in  proceedings  to  which  a  physician  was 
a  party  an  examination  of  his  books  of  accoun':;  before  trial  has 
been  refused  on  the  ground  of  privilege,  and  for  the  same  reason 
a  motion  to  direct  a  physician  to  turn  his  books  of  account 
over  to  a  receiver  has  been  denied.^ 

In  Montana  it  has  been  said  that  when  the  patient  consents 
no  one  else  can  object  to  the  reception  of  the  physician's  testi- 
mony.* 

In  New  York  it  has  been  said  that  the  benefits  of  the  law 
are  to  be  dispensed  alike  to  those  familiar  with  and  those  igno- 
rant of  its  existence  and  applicability,  and  it  is  therefore  no 
reason  to  refuse  its  enforcement,  that  the  patient  did  not  know 
that  his  communication  was  privileged." 

But,  as  in  other  cases  of  the  receipt  of  improper  evidence,  it 
would  seem  that  the  objection  should  be  made  at  the  time  it  is 
offered,  and  if  the  objection  is  not  then  made,  it  will  not  avail 
to  raise  it  later  or  on  appeal. "  It  should  not  be  prematurely  made. ' 
In  New  York  where  in  pursuance  of  a  special  feature  of  practice 
in  probate  proceedings,"  certain  witnesses  are  regarded  as  the 
surrogate's  witnesses  though  produced  at  the  instance  of  the  con- 
testant, and  the  contestant,  after  giving  notice  that  the  evidence 
of  physicians  as  such  witnesses  was  material,  refused  to  exam- 
ine them,  and  the  surrogate  required  the  proponent  to  suggest  a 
line  of  examination,  it  was  held  that  it  did  not  lie  with  the  con- 
testant to  object  to  the  physicians',  testimony  as  privileged, 
because  she  had  lost  her  right  to  object  by  giving  notice  that 
the  evidence  of  those  witnesses  on  these  points  was  material.^ 

Objection  cannot  be  raised  in  the  progress  of  an  examination 

'  Morris  tJ.  Morris,  119  Ind.,  341.  Breisenmeister  v.  Supreme  Lodge, 

"  Scrippsv.  Foster,  41  Mich.,  743.  etc.,  45  N.  W.  Eep.,  977  (Supr.  Ct. 

3  Mason  v.  Libbey,  2  Abb.  N.  C,  Mich.,  1890). 
137;   Mott  V.  Consumers'  Ice  Co.,  2         '  Valensin    v.  Valensin,    14    Pac. 

Abb.  N.  C,  143.  Rep.,  87  (Supr.  Ct.  Cal.,  1887). 

^  Territory  v.  Corbett,  3 Mont.,  50.  »  N.  Y.  Code  Civ.  Pro.,  s.  2,618. 

5  People    V.    Stout,    3    Park    Cr.  «  Hoyt  v.  Hoyt,  9  N.  Y.  St.  Rep. , 

Rep. ,  670  (N.  Y. ,  Oy.  and  Ter. ,  1858).  731  (N.  Y.  Supr.  Ct. ,  G.  T. ) ,  affirmed 

«  Johnsons.  Johnson,    14  Wend.,  112  N.  Y.,  493. 
636  (overruling  s.  c. ,  4  Paige,  460)  ; 


WAIVER   OF   THE   PRIVILEGE.  Ill 

after  the  forbidden  testimony  has  been  in  part  received  without 
objection;  for  that  would  unjustl}'  enable  a  party  to  open 
the  door  and  get  in  all  he  desired  and  then  to  close  it  to  the  dis- 
advantage of  his  adversary;  when  the  door  is  once  properly 
opened  the  examination  may  be  continued  until  it  is  complete, 
despite  the  objection  of  the  party  at  whose  instance  it  was 
begun.' 

In  Indiana,  where  there  was  no  objection,  it  was  held  that 
the  evidence  should  not  be  withdrawn  from  the  consideration 
of  the  jury  or  its  weight  diminished  by  comments  on  its  value 
as  matter  of  law.^ 

But  when  such  evidence  has  already  been  admitted  in  the 
face  of  objection,  it  is  not  necessary  for  the  party  to  object  again, 
as  nothing  is  waived  by  conforming  with  a  rule  already-  laid 
down.^  Where  it  is  apparent  that  no  harm  is  done  to  the  ob- 
jecting party  by  an  improper  ruling  on  the  receipt  of  privileged 
communications,  no  weight  will  be  given  to  an  exception  to 
such  ruling.^ 

What  Constitutes  a  Waiver  of  the  Privilege. — The  stat- 
utory provisions  as  to  what  constitutes  a  waiver  have  been  set 
forth  above.  ^  In  California  it  has  been  held  that  cross-exami- 
nation of  the  physician  by  the  patient,  calling  for  privileged 
matter,  is  a  waiver  of  privilege."  In  Indiana  it  has  been  held 
that  consent  to  disclosure  cannot  be  inferred  from  the  patient's 
simply  giving  the  name  of  his  family  physician  in  applying  for 
a  policy  of  insurance  on  his  life,  and  that  a  waiver  in  such  an 
application  should  be  evidenced  by  a  stipulation  too  plain  to  be 
misunderstood.'  And  a  physician's  statements  of  the  cause  of 
his  patient's  death,  furnished  to  an  insurance  companj^  in  pur- 
suance of  a  stipulation  of  a  policj"  that  satisfactory  proof  of 
death  shall  be  submitted  to  the  company,  are  not  rendered  ad- 
missible by  that  stipulation.* 

It  has  also  been  held  that  consent  to  the  evidence  of  one  phy- 
sician is  no  consent  that  another  physician  may  divulge  confi- 

1  Hoytv.  Hovt,  9  N.  Y.  St.  Rep.,  sValensin   v.   Valensin,    14   Pac. 

731  (N.  Y.  Sup'r.  Ct.,  G.  T.).  Rep..  87  (Supr.  Ct.  Cal.,  1887). 

'  Vau  Valkenburg  v.  Van  Valken-  ''  Masonic    Mut.     Ben.    Assn.    v. 

burp:,  90  Ind. ,  433.  Beck,  77  Ind. .  208. 

'  Dilleber  v.   Home  L.   I.  Co.,    69  « Dreier  v.  Continental  L.  I.  Co., 

N.  Y.,  256.  24 Fed. Rep..  670;  cf.  Breiseumeister 

••Loderv.  Whelpley,  111  N.  Y. ,  29.  v.  Supr.  Lodge,  etc. ,  45  N.  W.  Rep., 

*  Supra,  p.  96.  977  (Supr.  Ct.  Mich. ,  1890) . 


112  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

dential  communications ; '  and  that  the  physician  cannot  testify 
that  he  found  no  evidence  of  injury  on  the  examination  of  his 
patient,  in  order  to  contradict  her;'^  the  patient  had  already 
testified  as  to  her  condition  and  what  the  physician  had  done, 
but  not  as  to  anything  said  to  her  by  her  physician;  she  had 
expressly  declined  to  testify  concerning-  communications  except 
as  to  his  prescription  for  her  injury,  and  without  asking  him 
to  disprove  her  assertions  the  trial  Court  permitted  him  to  say 
that  he  had  found  no  evidence  of  injury;  this  was  held  to  be 
error.  It  has  also  been  held  that  the  taking  of  a  physician's 
deposition  and  filing  it,  for  the  purpose  of  breaking  the  force  of 
his  testimony  in  a  deposition  taken  by  the  opposite  party,  is 
no  consent  in  itself  to  the  reading  of  the  other  party's  depo- 
sition." But  when,  in  an  action  against  a  phj^sician  for  mal- 
practice, the  patient  testifies  as  to  the  manner  of  treatment,  the 
physician  is  then  at  liberty  to  introduce  the  testimony  of  him- 
self or  another  physician  as  to  the  facts  thus  put  in  issue  by 
the  patient/ 

In  Iowa  it  has  been  held  that  the  testimony  of  a  patient  re- 
garding the  condition  of  his  health  is  not  a  waiver  of  privilege, 
so  as  to  allow  his  opponent  to  introduce  the  testimony  of  his 
physician  to  contradict  him.^ 

In  Michigan  a  physician  has  been  allowed  to  contradict  his 
patient  as  to  the  time  when  her  trouble  commenced,  but  on  the 
ground  that  it  had  not  been  shown  that  the  information  was 
necessary  to  enable  him  to  prescribe."  But  it  has  been  held  that 
waiver  as  to  one  physician  is  not  waiver  as  to  another  regarding 
a  different  time.^ 

In  Missouri,  the  calling  of  a  physician  by  the  patient  as  a 
witness  to  testify  as  to  information  acquired  while  attending,  is 
a  waiver.®  But  offering  one  physician  as  a  witness  is  not  a 
waiver  of  the  privilege  with  reference  to  another.^  An  appli- 
cant for  insurance  maj^,  by  an  express  waiver  in  his  application, 

'  Penn  Mut.   L.   I.   Co.  v.  Wiler,  «  Campau  v.  North,  39  Mich. ,  606. 

100  Ind. ,  93.  '  Dolton  v.  Albion,  24  N.  W.  Rep. , 

2  Williams  v.  Johnson,  113  Ind. ,  373.  786. 

^Mtna  L.   I.  Co.  V.  Denning,  133  ^  Qj^j-j-jugton  v.  St.  Louis,  89  Mo., 

Ind. ,  390.  308  ;  Squires  v.  Chillicothe,  89  Mo. , 

*Lane  v.  Boicourt,  37 N.  E.  Rep.,  336:  Thompson  v.  Ish,  99  Mo.,  160. 

1111.  niellor  V.  Mo.   Pac.  Ry.  Co.,   14 

^McConnell  v.  City  of  Osage,  45  S.   W.   Rep.,   758;   16  S.  W.  Rep., 

N.  W.  Rep.,  550.  849. 


WAIVER   OF   THE   PRIVILEGE.  113 

make  an  efficient  waiver,  binding  upon  any  one  claiming  under 
the  contract  of  insurance. ' 

In  Nevada  a  waiver  has  been  implied  from  the  testimony  of 
the  patient  and  her  mother,  where  the  patient  was  an  infant 
seven  years  of  age."  And  it  was  said  that  the  parents  of  such 
an  infant  may  make  the  waiver. 

In  New  York  it  has  been  held  that  reference  to  a  family 
physician  when  answering  questions  on  an  application  for  in- 
surance, is  not  a  waiver ; ''  nor  is  the  presence  of  a  third  person 
in  aid  of  the  patient ; '  nor  is  the  bringing  of  an  action  for 
damages  for  an  injury ; '  nor  is  the  examination  of  the  physi- 
cian in  a  former  trial  by  the  opposing  party ; "  but  where  the  ban 
of  secrecy  is  once  removed  in  an  action  and  the  information 
once  lawfully  made  public,  at  the  instance  of  the  patient,  it 
cannot  be  restored,  and  the  disclosure  may  then  be  compelled  in 
any  subsequent  action ; '  it  would  seem,  too,  that  a  physician 
who  becomes  a  witness  to  his  patient's  last  will  and  testament 
at  the  patient's  request  is  then  subject  to  a  thorough  examina- 
tion on  all  points  involving  thepatient's  testamentary  capacity.' 

Where  the  patient  testified  herself  and  called  an  attending 
physician  to  prove  her  physical  condition,  this  was  not  a  con- 
sent to  the  examination  of  another  attending  physician,  and  it 
was  said  that  the  opposite  party  by  tactics  on  cross-examina- 

'  Adrereno  v.  Mut.  Res.  F.  L.  I.  in   People   v.  Schuyler,   106  N.  Y., 

Co. .  34  Fed.  Rep. ,  870.  298. 

-  State  V.  Depoister,  25  Pac.  Rep.,  *  See  In  re  Freeman,  46  Hun,  458, 

1000;  but  see  dissenting  opinion  of  in  which  a  will  was  admitted  to  pro- 

Bigelow,  J.  ;   see  also  McKinnev  v.  bate  on  the  concurrence  of  Learned, 

Grand  St.  R.  R.  Co.,  104  N.  Y.,  353.  J.,  who  held  that  the  relation  of 

^  Edington  i\    Mut.    L.  I.  Co.,   5  physician  and  surgeon  was  not  es- 

Hun,  1  (reversed  in  part  by  Eding-  tablished,  and  Landon,  J. ,  who  held 

ton  V.  Mut.  L.  I.  Co.,  67  N.  Y.,  185,  that  the  request  to  sign  constituted 

but  affirmed  on  this  point).  a  waiver  ;  Williams,  J.,  dissenting, 

*  Calien  r.  Continental  L.  I.  Co. ,  on  the  ground  that  the  relation  was 
41  N.  Y.  Super. ,  296  (overrviled  on  established  in  the  case,  and  the 
another  point  but  affirmed  on  this  waiver  could  not  be  assumed  with- 
in 69  N.  Y.,  300).  out  proof   of   the   patient's  mental 

■*  Jones  V.  Brooklyn,  B.  &  W.   E.  capacity' to  comprehend  the  waiver; 

Ry.  Co.,  3  N.  Y.  Supp. ,  253.  that   it  was    not  proper  to  assume 

^  Grattan  v.  Metrop.  L.  I.  Co.,  92  testator's   competency  to  waive  in 

N.  Y. ,  274.  order  to  enable  the  witness  to  testify 

'  McKinney  v.   Grand   St.   R.   R.  that  the  ]iatient  was  competent  to 

Co. ,  104  N.  Y. ,  352  ;  see  criticism  of  make  a  will. 

this  case  in  Breisenmeister  v.  Supr.  On  the  analogous  case  of  an  at- 

Lodge,  45  N.  W.  Rep.,   977   (Supr.  torney  as  witness  to  a  will,  see  Blnt- 

Ct.  of  Mich.,  1890).   'See  also  Mason  ter  of  Coleman,  111  N.  Y.,  220  :  and 

1'.  Libbey,  2Abb.  N.  C,  137;seeun-  N.    Y.    Code  Civ.    Pro.,    s.  836,    as 

answered  queries  on  similar  points  amended  Act  1893,  c.  295. 


114  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

tion  could  not  compel  the  patient  to  abandon  a  privilege  which 
she  refused  to  waive.'  Fish,  J.,  in  delivering  the  opinion  of 
the  Court  in  the  last-mentioned  case,  said  of  the  operation  of 
the  statute,  that  it  allows  the  patient  to  use  the  testimony 
of  the  attending  physician  if  he  thinks  his  evidence  will  bene- 
fit his  case,  and  to  object  and  exclude  it  in  case  he  thinks  it 
will  not  benefit  him ;  he  may  call  to  his  aid  the  testimony  of 
any  one  whose  views  he  approves  and  exclude  that  of  another 
whose  testimony  might  tend  to  controvert  that  given  with  the 
consent  of  the  patient ;  that  in  this  case  the  excluded  witness 
was  the  best  witness  and  could  tell  nothing  else  than  the  patient 
had  disclosed  if  she  had  told  the  truth  and  it  would  relate  solely 
to  what  she  and  the  other  physician  had  described,  but  that  the 
Court  could  not  consider  whether  the  statute  tended  to  promote 
the  cause  of  justice,  and  he  distinguished  McKinyiey  v.  Grand 
Street  Railroad  Company,'^  on  the  ground  that  there  the  con- 
sent had  been  that  the  same  phj^sician  should  disclose  what 
he  knew,  while  here  the  waiver  of  the  excluded  physician's  testi- 
mony had  been  constantly  withheld. 

A  decision  which  seems  to  be  at  variance  with  Record  i\ 
Village  of  Saratoga  Sjjrings  is  Treanor  v.  Manliattan  Rail- 
ivay  Company ^'^  where  it  was  said  that  the  patient  cannot  pro- 
mulgate and  uncover  his  maladies  and  infirmities  in  court  and 
keep  his  physician  under  obligations  to  silence,  and  that  he  can- 
not, to  mulct  another  in  damages,  inflame  a  jury  with  a  false  or 
exaggerated  stor}-  of  his  injuries  and  sufferings  and  preclude 
the  phj^sician  from  making  a  truthful  statement  of  the  case. 

But  where  the  patient  testifies  as  to  what  passed  between 
him  and  his  physician,  the  phj-^sician  maj'  testify  on  the  same 
subject,  as  a  waiver  is  inferred  from  the  circumstances ;  for  the 
reason,  that  the  patient,  having  gone  into  the  privileged  domain 
to  get  evidence  on  his  own  behalf,  cannot  prevent  the  other  party 
from  assailing  such  evidence  by  the  onXj  testimony  available, 
and  the  rule  is  no  longer  applicable  when  the  patient  himself 
pretends  to  give  the  circumstances  of  the  privileged  interview.* 

^  Record  v.    Village  of   Saratoga         ^  Supra,  p.  113,  note  7. 
Springs,    46  Hun,   448    (Supr.    Ct. ,  ^  28  Abb.  N.  C. ,  37   (N.  Y.   Com. 

Gen.  T.,  N.  Y.).     See  also  Hope  u.  PL,  Gen.  T.,  1891). 
Trov  and  Lansingburg  R.  R.  Co. ,  40         ^  Marx  v.  Manhattan  Rv.  Co. ,   56 

Hun,   438 :  Jones  v.   B. ,   B.   &   W.  Hun,   575  (N.   Y.   Supr.    Ct. ,    Gen. 

E.  R.  R.  Co.,  3N.  Y.  Supp.,  253.  T.). 


THE   EVIDENCE   EXCLUDED.  115 

The  requirement  that  a  physician  jEile  with  a  board  of  health  a 
certificate  of  the  cause  of  death  does  not  abrogate  the  privilege 
in  a  judicial  proceeding. ' 


The  Evidence  Excluded. 

^'Information.^'' — In  Arkansas,  California,  Colorado,  Idaho, 
Michigan,  Minnesota,  Missouri,  Montana,  Nevada,  New  York, 
North  Carolina,  North  Dakota,  Oregon,  South  Dakota,  Utah, 
Washington,  and  Wisconsin  the  privileged  matter  is  character- 
ized as  information.'' 

In  Arkansas  it  seems  that  the  information  must  be  a  confi- 
dential communication  J  ^  biit  in  the  other  States  where  it  has 
been  necessary  to  construe  the  word  it  has  received  a  broader 
interpretation. 

In  Michigan  information  is  not  confined  to  confidential 
communications  made  by  the  patient,  but  includes  whatever  in 
order  to  enable  a  physician  to  prescribe  was  disclosed  to  any  of 
his  senses  and  which  in  any  way  was  brought  to  his  knowledge 
for  that  purpose;^  it  covers  a  letter  written  to  a  physician," 
and  matters  observed  by  him ;  ®  but  it  does  not  include  infor- 
mation acquired  by  a  third  person;  for  instance,  the  time  when 
a  physician  saw  his  patient  may  be  disclosed  by  her  mother ; ' 
and  the  fact  of  treatment  or  non-treatment  is  not  information; " 
nor  are  the  facts  that  the  physician  was  the  patient's  famil}'  phy- 
sician, and  that  he  attended  him  professionally;  nor  are  state- 
ments of  the  dates  of  such  attendance  and  the  number  of  such 
visits ; "  nor  the  facts  that  the  phj'-sician  has  been  called  upon 
to  examine  and  prescribe  for  a  person  and  that  his  patient  had 
told  him  that  she  would  want  him  to  testify  for  her  in  a  law- 
suit." 

In  Missouri  the  statute  protects  information  received  from 

'  Buffalo  L.  &  T.  Co.  v.  Masonic  206  ;  Breisenmeister  v.  Supr.  Lodge, 

Mut.  Aid  Assn. ,  126  N.  Y. ,  450.  etc.,    45  N.    W.    Rep.,    977    (Supr. 

2  Supra,  p.  98.  Ct.  Mich.,  1890). 

»  Collins  V.    Mack,  31   Ark.,  684.  '  Dalman  v.  Koning,54  Mich.,32L 

The  main  point  of  this  decision  was  *  Brown   v.    Mut.    L.    I.    Co. ,    05 

that  the  information  was  not  neces-  Mich. ,  306. 

sary  ;  see  irifra.  p.  124.  *  Breisenmeister  v.  Supr.  Lodge, 

■*  Briggs  V.  Briggs,  20  Mich.,  34.  etc.,  45  N.  W.  Rep.,  977. 

6  Ihid.  '° Cooley  V.  Foltz,  48  N.  W.  Rep.. 

^Fraser   v.    Jennison,    42  Mich.,  176. 


116  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

the  patient;  but  this  is  not  confined  to  oral  communications, 
and  includes  knowledge  gained  by  inspection  of  the  patient's 
person.'  In  Lunz  v.  Massachusetts  Mutual  Life  Insurance 
Company  protection  was  said  not  to  extend  to  information  of 
this  sort  apparent  on  casual  inspection,  which  any  one  might 
make,  nor  to  symptoms  which  are  obvious  before  the  patient  sub- 
mits himself  to  any  examination,  such  as  an  inflamed  face,  a 
bloodshot  eye,  alcoholic  fumes,  or  delirium ;  nor  to  facts  so  su- 
perficial that  in  regard  to  them  no  confidence  could  have  been 
reposed.  But  this  distinction  between  hidden  and  patent  facts 
is  disapproved  in  Kling  v.  City  of  Kansas,'^  and  the  state- 
ment is  made  that  the  law  does  not  rest  on  the  confidence  im- 
posed. Knowledge  or  communications  concerning  the  cause  of 
a  patient's  condition  and  the  extent  of  his  injuries  have  also 
been  held  to  be  included  in  the  term  information,  because  the 
disclosure  of  these  matters  involved  the  indirect  disclosure  of 
the  condition ;  ^  but  it  was  said  that  the  physician  may  testify 
as  to  knowledge  acquired  independent  of  communications  from 
the  patient  and  of  examination  or  inspection  made  by  the  wit- 
ness for  the  purpose  of  treatment.^  As  divulging  privileged 
information,  a  physician  has  not  been  allowed  to  answer  what 
his  patient's  hurts  were,  why  he  left  a  hospital,  or  whether  he 
required  longer  treatment ;  ^  and  it  has  also  been  held  that  a 
physician  cannot  give  his  opinion  as  to  the  mental  condition  of 
his  patient  based  upon  privileged  knowledge.  ° 

In  New  York  information  comprehends  all  knowledge  ac- 
quired by  the  physician  by  communication,  observation,  or  in- 
spection ;  ^  it  has  been  said  to  extend  to  all  facts  which  neces- 
sarily come  to  the  knowledge  of  the  physician  in  a  given 
professional  case ;  ^  and  it  includes  as  well  the  opinion  of  the 
physician  based  upon  his  knowledge  as  the  knowledge  itself.* 

1  Lunz  V.  Mass.  Mut.  L.  I.  Co. ,  8  •*  Ibid. 

Mo.   App.,  .363;   Gartside  r.  Conn.  ^  Corbett  v.  St.  L.,  I.  M.  &S.  Ry. 

Mut.  L.  I.  Co.,  76  Mo.,  446  (said  to  Co.,  26  Mo.  App.,  631. 

be  overruled  by  85  Mo.,  249  ;  see  89  «  Thompson  v.  Ish,  99  Mo.,  160. 

Mo. ,  226,  but  followed  in  Tlioinpson  '  People  v.  Stout,  3  Park  Cr.  Rep. , 

V.  Ish,  99  Mo.,  160).     For  an  argu-  670. 

ment  on   the    distinction  between  *  Edington  v.    Mut.    L.  I.   Co. ,   5 

information    and    communications,  Hun,  1  ;  s.  p. ,  67  N.  Y. .  185  ;  Grattan 

see  brief  of  respondent's  counsel  in  v.  Met.  L.  I.  Co.,  80  N.  Y. ,  281. 

Gartside  v.  Conn.  JMut.  L.  I.  Co.  '^  Grattan  v.  Met.  L.  I.  Co. ,  80  N. 

''  27  Mo.  App. ,  231  (1887) .  Y. ,  281 ;  Van  Orman  v.  Van  Orman, 

3  Streeter  v.  City  of  Breckenridge,  34  N.  Y.  St.  Rep. .  824  (Supr.  Ct. ,  G. 

23  Mo.  App. ,  244.  T. )  ;  Wilcox  v.  Wilcox,  46  Hun,  32. 


THE   EVIDENCE   EXCLUDED,  117 

The  physician  cannot  disclose  the  nature  of  his  patient's  dis- 
ease, whether  he  learned  it  by  observation  or  examination  or 
from  what  his  patient  told  him ; '  nor  can  he  testify  as  to  what 
he  told  his  patient. '  In  Edington  v.  ^tna  Life  Insurance 
Company^  it  was  said  b}^  Judge  Earl  that  the  statute  was 
aimed  at  confidential  communications  and  secret  ailments,  and 
that  it  did  not  extend  to  matters  superficially  apparent,  such  as 
a  fever,  a  fractured  leg  or  skull,  or  raving  mania  apparent  to 
all;^  but  this  view  was  disapproved  expressly  in  the  later  case 
of  Renihan  v.  Dennin.  ^ 

The  privileged  information  has  been  said  to  include  knowl- 
edge acquired  through  the  statements  of  others  surrounding  the 
patient/  But  it  would  seem  that  the  fact  that  a  third  person 
was  present  during  a  physician's  visit  may  be  shown  b}-  the 
physician,  as  well  as  what  passed  between  the  patient  and  the 
third  person,  if  it  was  such  information  as  a  layman  would  have 
gathered/  The  information  from  the  third  person  regarding 
the  patient  is  protected  even  though  the  patient  be  absent ;"  but 
not  if  the  third  person  does  not  employ  the  physician,  and  the  in- 
formation thus  acquired  is  not  necessary  to  enable  the  physician 
to  act  in  a  professional  capacity/  It  is  suggested  in  one  case, 
but  not  determined,  that  it  would  be  improper  for  a  physician 
to  state  the  value  of  the  services  of  a  nurse  in  attendance  upon 
his  patient,  as  that  would  involve  a  consideration  of  the  con- 
dition of  his  patient; '"  but  it  has  been  held  that  a  physician  can 
testify  to  the  fact  of  a  nurse's  services/* 

But  it  is  information  regarding  the  patient  that  is  privileged, 
and  therefore  a  physician  may  disclose  what  his  patient  told 
him  about  another,  even  though  the  subject  of  inquirj^  be  the 
attitude  of  the  patient  toward  the  other ;  '^  and  likewise  the 
physician  may  disclose  what  he  told  his  patient  about  a  third 

'  Sloan  V.  N.  Y.  C.  R.  R.  Co..  45  L.   I.   Co.,  5  Hun,   1 ;  see  s.   c,   67 

N.  Y. ,  125  ;    Dilleber  v.  Home  L.  I.  N.  Y. ,  185. 

Co.,  69  N.  Y.,  256.  'Per  Smith,  J.,  in  Steele  r.  Ward, 

2  Cahen  x\  Continental  L.  I.  Co. ,  30  Hun,  555. 

69  N.  Y. ,  300.  «  People  v.  Brower,  53  Hun,  217. 

3  77  N.  Y. ,  564.  »  People  v.  Harris,  136  N.  Y.,  423. 
•»  See  also  Staunton  v.  Parker,  19  '"  Burlev  v.  Barnhard,  9  N.  Y.  St. 

Hun,  55.  Rep.,  587'(Supr.  Ct.,  G.  T.,  1887). 

5  103  N.  Y.,  573  ;  see  also  Grattan  "  Pandjiria  r.  MoQuillen,  37  N.  Y. 

V.  Met.  L.  I.  Co.,  80  N.  Y.,  281.  St. Rep.,  002  (Supr.  Ct.,  G.  T.,  1891). 

«  Grattan    v.    Nat.    L.    I.    Co.    of  '^  Hoyt  f.  Hoyt,  9  N.  Y.  St.  Rep., 

U.  S.,  15 Hun,  74;  Edington r.  Mut.  731  (Supr.  Ct,  G.  T.,  1887). 


118  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

person ; '  so  also  the  physician  may  testify  as  to  family  events 
in  no  way  connected  with  physical  complaints.^  It  has  been 
held,  too,  that  admissions  made  by  a  patient  to  his  physician, 
tending  to  show  contributory  negligence  on  the  part  of  the  pa- 
tient, at  a  time  when  the  communication  could  not  well  have 
been  made  to  enable  the  physician  to  prescribe,  namely,  on  the 
physician's  third  and  last  visit,  may  be  proven  by  the  physi- 
cian/ 

The  physician  may  properly  testify  that  he  did  attend  as 
physician,^  and  that  the  patient  was  sick,  and  he  can  state 
when  and  how  often  he  attended  him,  ^  and  whether  his  knowl- 
edge was  acquired  while  in  professional  attendance,  °  but  it  is 
open  to  the  Court  to  determine  from  the  evidence  whether  it 
was  so  acquired.' 

''^Matter  Committed.^'' — In  Indiana  the  protection  covers 
matter  committed.  It  would  seem  that  the  use  of  the  word 
committed  implies  confidence  and  that  the  protected  matter  is 
only  confidential  communications;  but  an  earlier  statute  in  that 
State  applied  to  "matters  confided,"  and  it  was  held  to  cover 
matters  learned  b}'  observation  or  examination,  or  by  commu- 
nication from  the  patient,  whether  learned  under  an  injunction 
of  secrecy,  express  or  implied,  or  not ;  *  and  it  has  been  held 
that  the  present  law  forbids  the  disclosure  of  matters  learned  in 
a  sick-room,  no  matter  how  the  knowledge  may  have  been  ac- 
quired.^ 

"  Confidential  Communications." — The  laws  of  Iowa  and 
Nebraska  protect  confidential  communications  properly  in- 
trusted. The  construction  put  upon  the  word  confided  in  In- 
diana has  been  shown.  In  Iowa  it  has  been  said  that  a  confi- 
dential inquiry  for  advice  to  facilitate  the  commission  of  a  crime 
or  the  infraction  of  law,  is  not  properly  intrusted  and  is  not 
privileged;'"  but  where   the  advice    is  sought  for   a  purpose 

'  Hoyt  V.  Hoyt,  ibid.  ^  In  matter  of  Darragh,  15  N.  Y. 

-  In  matter  of  Boury,  8  N.  Y.  St.  St.  Rep.,  452  (N.  Y.  Sm-r.). 

Rep.,  809  (Supr.  Ct..  G.  T.,  1889).  '  In  matter  of  Darragh,  52  Hun, 

3  Brown  v.  R.  W.  &  O.  R.  R.  Co.,  591  (Supr.  Ct.,  G.  T.),  see  infra,  p. 

45  Hun,  439.  128. 

■*  Numirich  v.  Supr.  Lodge  K.  &  L.  *  Masonic    Mut.    Ben.    Assn.    v. 

of  H. .    3   N.    Y.   Supp. ,  552  (Trial  Beck,  77  Ind. ,  203. 

Term,  City  Ct.  of  N.  Y.,  1889)  ;  Pat-  «  Heuston  v.   Simpson,   115  Ind., 

ten  V.  U.   L.   &  A.   Ins.  Assn.,    133  62:    Penna.   Co.   v.   Marion,    28  N. 

N.  Y.,  450.  E.  Rep.,  973. 

5  Patten  v.   United  L.   &  A.  Ins.  '°  Guptill  v.  Verback,  58  Iowa,  98. 
Assn.,  133  N.  Y.,  450. 


THE   EVIDENCE   EXCLUDED.  119 

which  maj'"  or  may  not  be  lawful,  the  presumption  is  that  it  is 
lawful,  and  the  communication  is  privileged.'  It  has  been  said 
that  whether  or  not  a  physician  treated  a  person  for  a  particular 
disease,  is  not  a  confidential  communication.^ 

The  word  confidential  is  not  narrowly  construed,  for  a  phy- 
sician has  been  prevented  from  disclosing  whether  his  patient 
said  that  a  car  was  in  motion  when  he  was  injured,  because  the 
injury  would  be  more  severe  if  in  motion ;  ^  and  the  fact  that 
the  physician's  pai-tner  was  present  does  not  remove  the  seal  of 
secrecy,  or  permit  the  partner  to  testify.^ 

"  Communications.^'' — In  Ohio  and  Wyoming  commit ni ca- 
tions are -privileged ;  and  in  Kansas  and  Oklahoma  communi- 
cations with  reference  to  a  physical  or  supposed  physical  disease 
and  any  knowledge  obtained  by  a  personal  examination  of  a 
patient.  It  does  not  appear  whether  a  narrower  construction 
would  be  given  to  the  term  communications  than  to  the  term 
information;  but  it  would  seem  not,  if  a  person  deprived  of 
speech  is  to  be  protected,^  or  if  the  term  communications  is 
not  to  be  construed  as  meaning  oral  communications. 

''From  the  Patient;  by  the  Patient." — The  former  quali- 
fying terms  are  used  in  the  statutes  of  Arkansas,  Indian  Terri- 
tory, and.  Missouri ;  the  latter  in  the  statutes  of  Kansas  and 
Oklahoma.  The  liberal  interpretation  put  upon  this  term  in 
the  Missouri  law  has  already  been  shown."  The  law  of  the 
Indian  Territorj?^  is  adopted  from  Arkansas.'  The  statute  is 
stricth^  construed  in  Arkansas,'  but  this  term  does  not  seem 
to  have  received  interpretation. 

"  Advice."— The  laws  of  Indiana,  Ohio,  and  Wyoming  ex- 
pressly cover  the  physician's  advice.  In  New  York  it  is  in- 
competent for  the  physician  to  disclose  what  he  told  his  patient ; " 
but  advice  to  a  patient  concerning  a  third  person  is  not  privi- 
leged.'" 

The  Relation  of  Physician  and  P«f?enf.— Under  each  of  the 

'  Guptill  V.  Verback,  58  Iowa,  98.  in  brief  for  respondent.  Gartside  v. 

-'McConnell  v.  City  of  Osage,  45  Conn.  Mut.  L.  I.  Co.,  76  Mo.,  446. 
N.  W.  Rep.,  550.  ^  Supra,  p.  115. 

3  Raymond  v.  Burlington,  C.  R.  &         ■"  Act  of  Congress,  May  2d,  1890, 
N.  Ry.  Co.,  65  Iowa,  152.  c.  182. 

4  ihid.  "  Collins  V.  Mack,  31  Ark..  684. 

^  See    argument  in    Edington  v.  ^  Cahen  v.  Continental  L.  I-  |~"o.. 

Mut.  L.  I.  Co.,  67  N.  Y.,  185.     See  69  N.  Y.,  300:  see  Grattan  v.  Met. 

argument    for    difference    between  L.  I.  Co.,  24  Hun.  43. 
information    and     communications         '"  Hoyt  r.  Hoyt,  112  N.  Y.,  49d. 


120  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

statutes,  the  relation  of  physician  and  patient  must  have  existed 
at  the  time  the  information  was  acquired.  In  those  cases  where 
the  relation  is  established  by  contract  and  is  recognized  by  both 
physician  and  patient  as  existing,  no  difficulty  arises  in  deter- 
mining that  it  does  exist.  It  is  in  those  cases  where  some  one 
of  these  elements  is  lacking  that  the  difficulties  are  met.  In 
California  it  has  been  held  that  the  relation  exists  where  a  phy- 
sician attends  and  prescribes  for  a  person,  notwithstanding  he 
was  employed  by  another,  who  seeks  to  disclose  the  evidence.* 
In  Michigan,  where  the  physician  was  employed  by  direction  of 
the  prosecuting  attorney  to  examine  the  defendant  in  jail,  and 
so  notified  the  defendant  at  the  outset  of  the  examination,  and 
he  submitted  voluntarily  to  a  personal  examination,  and  there 
was  no  intention  to  prescribe  or  to  act  as  the  defendant's  phy- 
sician, it  was  held  that  the  relation  did  not  exist,  and  that  the 
physician  could  testify  as  to  the  defendant's  physical  condition." 

In  one  New  York  case  it  has  been  said  that  the  relation  is 
one  of  contract,  and  that  the  test  is  whether  the  physician  would 
be  chargeable  with  malpractice  or  negligence  for  failure  to  ad- 
vise or  prescribe  in  case  the  alleged  patient  were  in  urgent  need 
of  it  at  the  time.^  But  the  decisions  of  the  Court  of  Appeals 
extend  the  privilege  to  cases  where  this  test  would  lead  to  a 
different  conclusion.^ 

Where  the  physician  to  a  county  jail  was  called  in  to  attend 
a  prisoner  and  examined  him,  though  there  was  no  prescription 
at  the  time,  but  it  appeared  that  the  doctor  told  the  prisoner 
what  he  should  prescribe,  and  subsequently  two  phj^sicians 
came  to  see  the  prisoner  at  the  instance  of  the  coroner  and  ex- 
amined him  as  they  would  have  examined  one  of  their  patients, 
though  they  did  not  prescribe  and  had  no  conversation  about  a 
prescription,  it  was  held  that  the  prisoner  had,  under  the  circum- 
stances, reason  to  suppose  that  the  relation  of  physician  and  pa- 
tient did  exist  between  him  and  all  three  of  the  physicians,  and 
that  their  testimony  as  to  what  they  learned  on  such  visits 
should  have  been  excluded ;  and  the  rule  is  thus  stated :  when- 
ever the  patient  has  reason  to  suppose  that  the  relation  exists 
and  does  in  fact  and  truth  so  suppose,  in  a  case  where  the  phy- 

'  Freel  v.  Market  St.  Cable    Ry.  Freeman,  46  Hun,   458   (Supr.   Ct. , 

Co.,  31  Pac.  Rep.,  730.  Gen.  T.,  1887). 

-  People  V.  Glover,  71  Mich.,  303.  ^  Renihan  v.   Dennin,   103  N.  Y., 

^  Per  Learned,   J. ,  In  matter  of  573  ;  and  cases  in  notes  following. 


THE   EVIDENCE   EXCLUDED.  121 

sician  attends  under  circumstances  calculated  to  induce  the 
opinion  that  his  visit  is  of  a  professional  nature,  and  the  visit 
is  so  regarded  and  acted  upon  by  the  person  attended,  the 
relation  of  physician  and  patient  contemplated  by  the  statute 
may  fairly  be  said  to  exist/ 

But  the  fact  that  it  is  the  duty  of  a  physician  to  prescribe 
for  a  person  in  case  of  need,  does  not  constitute  the  relation, 
though  the  position  of  the  physician  gives  him  the  opportunity 
to  observe  such  person ;  so,  therefore,  a  jail  physician  was  not 
precluded  from  testifying  as  to  what  he  had  observed  of  a  pris- 
oner, where  it  did  not  appear  that  he  Jiad  ever  attended  the 
latter  in  a  professional  capacity  or  had  ever  been  called  on  to 
attend  him/ 

It  would  seem,  however,  that  where  it  is  the  duty  of  a  phy- 
sician to  attend  a  person  in  a  professional  capacity  or  to  acquire 
knowledge  concerning  him  in  such  capacity,  he  cannot  dis- 
close information  actually  acquired  in  the  performance  of  his 
duty.  It  has  been  said  that  a  medical  attendant  at  an  in- 
sane asylum  cannot  testify  as  to  the  mental  condition  of  an  in- 
mate ; '  and  that  a  physician  employed  in  a  hospital  to  notice 
and  enter  in  its  records  the  arrival  and  condition  of  the  patients 
coming  in,  cannot  testify  as  to  information  so  acquired.^ 

It  is  immaterial  that  another  person  employs  the  phj^sician 
to  examine  the  patient,  and  to  report  to  the  employer,  and  that 
the  person  examined  does  not  appear  to  desire  any  knowledge 
as  to  his  condition;  if  the  examination  is  made  as  a  professional 
act,  the  relation  of  physician  and  patient  is  established  between 
the  physician  and  the  person  examined,  even  though  it  be  the 
only  interview.^ 

And  in  a  case  where  the  public  prosecutor  sent  a  physician 
to  a  person  for  the  purpose  of  making  a  professional  examina- 
tion, so  as  to  obtain  evidence  against  another  person  charged 
with  crime,  and  the  person  examined  accepted  the  services  of 

1  People  V.  Stout,  3  Park  Cr.  ^  In  matter  of  Baird.  11  N.  Y.  St. 
Rep.,  670 (N.  Y.  Oy.  andTer.,  1858)  ;  Rep.,  263  (N.  Y.  Supr.  Ct..  Cham- 
see  Grossman  r.Siijneme  Lodge,  etc. ,  bers,  1887,  per  Donohue,  J.). 
6  N.  Y.  Supp.,  821  (Gen.  T.  Supr.  *  See  28  Abb.  N.  C.  55.  note. 
Ct. ,  1889),  visiting-  physician  at  a  ^  Grattan  v.  Met.  L.  I.  Co..  24 
hospital  attending  out  of  curiosity  Hun,  43  (Supr.  Ct.,  Gen.  T.,  1881)  ; 
with  regular  plivsician.  92  N.  Y.,  274. 

•^People  V.   S^lnlvler,   106  N.  Y., 
298,  affirming  43  Hun,  88. 


122  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

the  physician  in  a  professional  character,  it  was  held  that  h& 
could  not  testify  as  to  the  results  of  his  examination.' 

But  where  the  district  attorney  sent  a  physician  to  jail  to 
make  an  examination  of  a  prisoner's  mental  and  physical  con- 
dition, and  he  made  such  examination,  and  it  did  not  appear 
that  he  prescribed  for  or  treated  the  prisoner  or  that  the  prisoner 
accepted  his  services,  the  opinion  of  the  physician  as  to  his 
mental  condition  was  admitted. "^ 

Where  the  defendant  employed  a  physician  to  examine  the 
plaintiff,  and  he  went  as  coming  from  the  defendant  for  that 
purpose,  and  examined  i;he  plaintiff  in  the  presence  of  his  attend- 
ing physician,  but  not  as  the  plaintiff's  physician  and  not  for 
the  purpose  of  prescribing,  the  relation  of  physician  and  patient 
was  not  established.''  Where  a  physician  examined  the  plain- 
tiff at  the  instance  of  the  plaintiff's  physician,  but  it  was  not 
shown  that  he  was  requested  or  expected  to  treat  or  prescribe 
or  to  advise  in  respect  to  either,  or  that  he  did  either,  it  was 
held  that  the  relation  was  not  established;''  but  a  physician 
consulted  by  the  patient's  regular  physician  for  the  purpose  of 
advice  concerning  his  treatment  is  a  physician  contemplated  by 
the  statute ;  ^  as  is  also  the  partner  of  a  physician  who  is  pres- 
ent during  a  conference  with  the  patient  or  who  overhears  such 
a  conference."  Attendance  at  the  patient's  house  is  not  con- 
templated as  essential  by  the  law,  and  it  makes  no  difference 
where  the  examination  is  conducted.''  But  where  the  physi- 
cian was  also  a  county  clerk  and  the  alleged  patient  was  an  at- 
torney, and  the  consultation  took  place  in  the  clerk's  office  and 
consisted  of  an  examination  of  an  eruption  on  the  skin,  which 
was  made  gratuitously  and  without  a  prescription  being  made 
or  asked  for,  the  relation  was  held  not  to  have  been  established, 
notwithstanding  that  the  clerk  made  use  of  his  knowledge  and 
learning  as  a  physician  in  forming  his  opinion,  and  that  it  was 


1  People  V.  Murphy,  101  N.  Y.,  R.  Co.,  57  Hun,  76  (Supr.  Ct.,  Gen. 
126.  T.,  1890). 

2  People  V.  Kemmler,  119  N.  Y.,  ^  Reuihan  v.  Dennin.  103  N.  Y., 
580;  People  V.  Sliney,  187  N.  Y.,  573;  Jones -y.  B.,  B.  &  W.  E.  Ry. 
570.  Co.,  3N.  Y.  Supp.,  258. 

^  Heath  v.  Broadway  &  S.  A.  Ry.  ^  ^^tna  L.  I.  Co.  v.  Deming,   123 

Co.,  8  N.  Y.  Supp.,  863  (Super.  Ct.,  Ind.,  390 ;  Raymond  v.  B.,  C.  R.  & 

Gen.  T.,  1890).  N.  Ry.  Co.,  65  Iowa,  153. 

*  Henry  t).  N.  Y.,    L.  E.  &  W.  R.  ■  Grattan  v.  Metr.  L.   I.   Co.,    24 

Hun,  48  (Supr.  Ct.,  Gen.  T.,  1881). 


THE   EVIDENCE   EXCLUDED.  123 

in  confidence  that  he  possessed  medical  skill  that  the  person  re- 
quested the  examination.' 

It  does  not  follow  that  the  relation  once  established  continues 
always ;  the  secrecy  growing  out  of  the  relationship,  as  to  knowl- 
edge then  acquired,  always  continues  unless  properly  waived; 
and  the  physician  will  not  be  allowed  to  testify  in  regard  to 
matter  Avhich  is  partly  the  result  of  such  information,  though  an- 
other part  may  have  been  acquired  independent  of  the  relation ;  ^ 
but  where  it  is  clear  that  the  matter  desired  is  independent  of 
the  relation  of  physician  and  patient,  such  evidence  is  admissi- 
ble if  otherwise  competent.^  , 

'■'  Professional  Capacity.'' — The  States  in  which  the  statutes 
limit  the  privilege  to  information  acquired  in  a  professional  ca- 
pacity have  been  enumerated."  As  to  what  constitutes  a  pro- 
fessional capacity,  the  discussion  of  the  facts  that  establish  the 
relation  of  physician  and  patient,  and  of  the  information  neces- 
sary to  enable  a  physician  to  prescribe  or  a  surgeon  to  act,  makes 
it  unnecessary  to  discuss  at  length  the  meaning  of  this  phrase. 
The  decision  in  Lunz  v.  Massachusetts  Mutual  Life  Insurance 
Companij  ^  would  make  it  appear  that  in  Missouri  information 
apparent  on  a  casual  inspection  which  any  one  might  make  is 
not  received  in  a  professional  capacity,  but  this  idea  is  disap- 
proved in  the  later  case  of  Kling  v.  City  of  Kansas."  Infor- 
mation acquired  by  the  physician  b}'  observing  the  patient  on 
the  street  anterior  to  his  employment  as  a  physician  is  not  re- 
ceived by  him  in  a  professional  capacity.' 

In  New  York,  where  the  physician  had  not  seen  the  patient 
before  or  since  his  interview  for  the  purpose  of  treatment,  and 
he  was  asked  what  his  opinion  was,  based  on  a  general  sight  of 
the  man  before  the  examination,  it  was  held  that  the  physician 
could  not  properly  answer,  as  all  the  information  upon  which 

'Edingtont).  ^tna   L.  I.  Co.,  13  ham  v.   Gott,   3  N.   Y.  Supp.,   518 

Hiin,  543  (Supr.  Ct.,  Gen.  T.,  1878),  (Supr.  Ct.,  Gen.  T.,  1889). 

affirmed  77  N.  Y.,  564.     The  broad  =*  Stowell     v.     American     Co-op. 

expressions  of  this  latter  case  were  Assn.,  23  N.  Y.  St.  Rep.,  706  (Supr. 

disapproved  in  Renihan  v.  Dennin,  Ct.,  Gen.  T.,  1889). 

103  N.  Y.,  573,  but  it  does  not  appear  ■*  Supra,  p.  98. 

that  this  point  was  not  properly  de-  *  8  Mo.  App.,  363. 

cided.  «27Mo.  App.,  231. 

2  In  matter  of  Darragh,  52  Hun,  '  (rartside  v.  Conn.  Mut.  L.  I.  Co., 

591  (Supr.  Ct.,  Gen.  T.,  1889),  15  N.  76   Mo.,    446:    see    also    Burlev   v. 

Y.  St.  Rep.,  452  (N.Y.  Surr.)  :  Brig-  Barnhard.  9  N.  Y.  St.  Rep.,  587  (N. 

Y.  Supr.  Ct.,  Gen.  T.). 


124  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

the  opinion  would  be  based  must  have  been  acquired  in  a  pro- 
fessional capacity ; '  but  in  another  case  a  physician  was  per- 
mitted to  express  his  opinion  as  to  the  mental  condition  of  a 
patient  whom  he  had  seen  at  various  times  when  not  in  attend- 
ance, excluding  from  his  mind  any  knowledge  or  information 
obtained  while  acting  as  her  medical  attendant  and  confining 
his  answer  to  such  knowledge  and  information  as  he  had  ob- 
tained by  seeing  her  when  not  his  patient.^  It  has  been  said 
that  where  information  is  not  such  as  is  obtained  on  sight  by  any 
person,  but  by  removing  clothing  and  by  percussion  and  listen- 
ing to  the  action  of  the  lungs,  these  are  professional  acts  and 
the  information  may  be  considered  as  obtained  professionally.* 
It  has  been  said  that  information  received  in  a  professional 
capacity  involves  a  decision,  though  it  may  be  negative ;  and 
that  signing  as  witness  to  a  will  is  not  a  professional  act.^ 

Matter  Necessar^y  to  Enable  a  Physician  to  Prescribe  or 
a  Surgeon  to  Act. — A  list  of  those  States  whose  laws  limit  the 
privilege  to  matter  necessary  to  enable  the  witness  to  prescribe 
or  act  for  the  patient  is  to  be  found  in  another  place. ^ 

In  Arkansas,  where  six  hours  after  deliver}",  the  patient 
stated  to  her  physician  who  attended  at  accouchement,  that  she 
had  never  been  engaged  to  marry  and  never  had  promised  to 
marry,  the  statements  were  held  not  to  be  necessary  to  enable 
the  physician  to  act.'' 

In  Iowa,  a  physician  who  had  treated  a  patient  for  injuries 
was  not  allowed  to  testify  whether  his  patient  told  him  that  the 
car  on  which  he  was  injured  was  in  motion  at  the  time,  because 
as  the  injury  would  be  likely  to  be  more  severe  if  the  car  was  in 
motion,  that  information  was  necessary  to  enable  the  physician 
io  prescribe.' 

In  Michigan,  a  phj^sician  was  allowed  to  contradict  his  pa- 
tient as  to  when  her  trouble  commenced,  in  the  absence  of  evi- 
dence that  such  information  was  necessary  to  enable  him  to  act.® 
Where  a  physician  was  asked  whether  he  treated  a  person  for 

'Grattan  v.   Metr.   L.   I.   Co.,   92  *  Per  Learned,   J.,   In  matter  of 

N.  Y.,  274.  Freeman,  46  Hun,  458. 

2  Fisher    v.    Fisher,    129    N.    Y.,  ^  Supra,  ]).  ^?<. 

654.  «  Collins  v.  Mack,  31  Ark.,  684. 

^Grattan    v.    Metr.    L.    I.    Co.,  'Raymond  v.   B..  C.  R.   &  Nor. 

34    Hun,    43   (Supr.  Ct.,    Gen.   T.,  Rv.  Co.,  65  Iowa,  152. 

1881) .  '»  Campau  v.  North,  39  Mich.,  606. 


THE   EVIDENCE   EXCLUDED.  125 

typhoid  fever,  and  he  answered  that  she  was  not  so  diseased, 
it  was  held  that  this  information  was  not  necessary  to  enable 
him  to  act.'  And  the  same  was  held  to  be  true  where  a  phy- 
sician examined  a  prisoner  at  the  jail  and  testified  that  he  was 
diseased,  the  prisoner  having  been  notified  at  the  time  of  the 
examination  that  it  was  made  by  direction  of  the  prosecuting 
attorney  and  there  being  no  intention  to  prescribe  or  act  for  the 
prisoner.  "^  But  it  has  been  stated  that  all  disclosures  by  a  pa- 
tient to  a  phj^sician  respecting  ailments  are  privileged  whether 
necessary  to  enable  the  physician  to  prescribe  or  not.^ 

In  Minnesota,  a  physician  was  allowed  to  disclose  statements 
as  to  suffering  made  by  his  patient,  but  not  for  the  purpose  of 
enabling  him  to  prescribe  or  act.^ 

In  Missouri,  it  has  been  said  that  information  as  to  the  way 
in  which  an  injury  was  inflicted  is  of  the  greatest  necessit}^  for 
successful  treatment ;  and  that  it  is  information  which  physi- 
cians universally  demand  and  receive.^  In  another  case,  with 
reference  to  the  cause  of  a  patient's  condition,  it  was  said  that 
while  knowledge  of  the  cause  may  not  be  necessary,  the  disclos- 
ure of  the  cause  cannot  be  made  without  a  disclosure  of  the 
condition,  and  that  as  a  medical  person  cannot  tell  indirectly 
what  he  is  forbidden  to  tell  directly,  the  physician's  evidence  of 
the  cause  is  inadmissible.''  In  another  case  it  was  said  that 
any  information,  necessarily  coming  to  a  physician  in  order  to 
treat  his  patient,  is  to  be  regarded  as  necessary  information 
though  unimportant,  and  that  the  test  is  how  it  was  acquired,  not 
whether  it  could  have  been  acquired  in  a  different  way,  and 
therefore  it  was  incompetent  for  a  physician  to  testify  that  his 
patient  was  drunk  when  he  treated  him.' 

In  New  York,  in  an  earlj'^  case,*  where  a  man  consulted  a 
physician  with  reference  to  committing  an  abortion  and  told 
him  that  a  certain  woman  was  pregnant  by  him,  this  admission 
was  said  not  to  be  essential  to  enable  him  to  prescribe,  even  if 

'  Brown  1).    Metr.    L.    I.    Co.,    65  ^  Streeter  ■?;.  City  of  Breckenridge, 

Mich.,  306.  23  Mo.  App.,  244. 

2  People  -y.  Glover,  71  Mich.,  303.  '  Kling  v.  City  of  Kansas,  27  Mo. 

^ Breisennieister  r.  Supr.   Lodge,  App.,    231. 

etc.,  45  N.  W.  Rep.,  977  (Supr.  Ct.  «  Hewitt  v.  Prime,  21  Wend..  77 

Mich.,  1890).  (N.  Y.  Supr.  Ct.  of  Judic.   1839). 

•*  Jacobs  V.  Cross,  19  Minn.,  523.  See  Edinp:ton  v.  Mut.   L.  I.  Co.,   67 

5  Norton  v.   City  of  Moberly,  18  N.  Y.,  185. 
Mo.  App.,  457. 


126  CONFIDENTIAL  COMMUNICATIONS — BOSTON. 

the  relation  of  physician  and  patient  were  considered  established ; 
but  this  seems  to  be  at  variance  with  the  later  case  of  People  v. 
Brower,^  where  the  accused  consulted  a  physician  with  refer- 
ence to  the  treatment  of  a  woman  on  whom  he  had  attempted  to 
commit  an  abortion,  and  admitted  that  he  had  done  so,  and  the 
physician  was  not  permitted  to  disclose  it.  A  broader  view 
is  now  taken  of  the  word  necessary.  It  has  been  held  by  the 
Court  of  Appeals  that  a  physician  could  not  testify  that  his 
patient  had  a  venereal  disease  while  under  his  care  as  a  physi- 
cian, the  presumption  being  that  he  learned  it  for  the  purpose 
of  prescribing;^  and  again,  that  it  is  assumed  from  the  rela- 
tionship that  the  information  would  not  have  been  imparted  ex- 
cept for  the  purpose  of  aiding  the  physician  to  prescribe."  But 
this  presumption  does  not  attach  to  information  regarding  a  pa- 
tient, communicated  by  a  third  person." 

Where  a  person  went  to  a  physician  to  call  for  medicine, 
and  it  appeared  that  he  was  not  consulting  for  himself  and  was 
not  representing  any  one  else  who  needed  or  desired  medical 
assistance,  the  physician  was  allowed  to  testify  as  to  a  conversa- 
tion which  took  place  at  that  time.^ 

In  the  case  of  Edington  v.  ^tna  Life  Insurance  Company," 
it  was  said  that  before  the  exclusion,  the  facts  on  which  it  is 
justified  must  appear  in  some  way,  and  the  Court  must  know 
somewhat  of  the  circumstances ;  from  the  opinion  it  is  easy  to 
infer  that  it  is  only  confidential  communications  and  informa- 
tion as  to  secret  ailments  which  may  be  regarded  as  necessary 
within  the  statute ;  but  this  view  was  overruled  in  Grattan  v. 
Metropolitan  Life  Insurance  Company,'' andthere  it  was  dis- 
tinctly stated  that  it  is  enough  that  the  witness  acquired  the 
information  in  his  character  as  physician  and  in  the  due  and 
proper  exercise  of  his  calling,  and  that  it  is  not  incumbent  on 
the  person  objecting,  to  show  by  formal  proof  that  the  informa- 
tion was  necessary  to  enable  the  witness  to  prescribe.  In  this 
case  the  examination  of  the  witness  was  as  to  the  cause  of  his 

'  53  Hun,  217  (Supr.  Ct.,  Gen.T.,  *  People    v.   Harris,    136    N.    Y., 

1889) .  423. 

^  Sloan  V.  N.  Y.  C.  R.  R.  Co.,  45  ^  Babcock  v.  People,  15  Hun,  347 ; 

N.  Y.,  125.  see  also  People  v.  Harris,  supra. 

3  Edington  v.  Mut.  L.   I.  Co..  67  «  77  N.  Y.,  564;  see  also  s.  p.,  17 

N.    Y.,    185.     See    also    People    v.  W.  D.,  566. 

Stout,   3  Park  Cr.  Rep.,  670  (N.  Y.  '  80  N.  Y.,  281. 
Oy.  andTer..  1858). 


THE    EVIDENCE   EXCLUDED.  127 

patient's  death,  and  the  argument  urged  upon  the  attention  of 
the  Court  was  that  information  regarding  the  cause  of  death 
could  not  be  necessary  to  enable  the  physician  to  prescribe,  as 
the  utility  of  the  prescription  ceased  with  the  death  and  before 
the  cause  was  determined ;  but  the  Court  held  that  the  privilege 
attached,  because,  although  the  death  was  the  result  of  the  cause, 
the  facts  constituting  the  cause  were  learned  while  the  physician 
was  attending  the  living  patient  in  a  professional  capacity  and 
from  the  symptoms  manifested  at  that  time. 

In  consonance  with  the  decision  in  Grattanv.  Metropolitan 
Life  Insurance  Company,^  it  has  been  held  that  a  phj-sician 
who  amputated  a  patient's  leg  could  not  testify  as  to  its  condi- 
tion at  the  time  it  was  amputated." 

The  fact  that  the  physician  does  not  prescribe  does  not  de- 
feat the  privilege ;  if  the  information  is  acquired  in  the  course 
of  professional  employment  the  statute  operates,  for  the  decision 
that  neither  advice  nor  medicine  is  needed  is  a  professional  act 
within  the  spirit  of  the  law.^  Medicus  optimns,  medicanien- 
tum  minimum,  is  the  maxim  used  in  another  case  to  illustrate 
this  point. " 

But  it  cannot  be  predicated  as  matter  of  law  that  a  physician 
cannot  exclude  from  his  consideration  facts  learned  or  opinions 
formed  while  attending  as  physician ;  therefore  he  can  testify 
as  to  his  opinion  on  hypothetical  facts  which  might  be  deemed 
to  relate  to  another  person  as  well  as  the  patient ;  and  where 
the  physician  testified  that  he  could  so  form  an  opinion,  his 
opinion  of  such  assumptions  was  held  to  be  admissible  in  evi- 
dence as  expert  testimony.^ 

But  it  is  not  all  information  which  will  be  presumed  to  have 
been  necessary  to  enable  the  physician  to  act;  it  seems  that 
where  the  knowledge  is  such  that  it  is  evidently  immaterial  to 
the  physician's  decision,  it  will  be  admitted.  Such  a  case  is 
that  of  Hoijt  V.  Hoyt,'  where  the  testimonj^  of  physicians  was 
admitted  to  show  the  attitude  of  their  patient  toward  his  daugh- 

'  80  N.  Y.,  281.  '  People  v.  Sclmyler,  43  Hun.  88, 

'•'Jones    V.    Brooklyn,    Bath    and  affirmed  106  N.  Y.,' 298. 

West  End  Rv.  Co.,  3N.Y.  Supp.,  253  «  9  N.  Y.  St.  Rep.,  731  (Supr.  Ct.. 

(City  Ct.  of  Brooklyn,  Gen. T.,  1888).  Gen.  T.),  affirmed  112    N.  Y.,  493. 

^  Grattan  v.  Metr.  L.    I.  Co.,   24  Although  this  point  was  discussed, 

Hun,  43  (Supr.  Ct..  Gen.  T.,  1881).  the  case  was  really  decided  on  the 

■*  In  matter  of  Freeman,  46  Hun,  ground  that   the  ohjector  had  lost 

458.  her  right  to  object  if  she  ever  had  it. 


128  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

ter  and  their  advice  to  him  concerning  her,  the  evidence  being 
for  the  purpose  of  showing  the  testator's  opinion  and  not  th& 
physicians'.  It  has  also  been  held  that  a  statement  made  by  a 
patient  on  the  physician's  last  visit  as  to  what  occurrred  at  the 
time  the  patient  was  injured,  tending  to  show  contributory  neg- 
ligence, was  not  necessary  information.'  And  a  physician's 
evidence  of  the  declaration  of  his  patient  as  to  making  a  will 
and  the  doctor's  advice  on  that  subject  have  been  admitted.^ 

THE  PROVINCE  OF  THE  COURT  IN  DEALING  WITH  THE 
PRIVILEGE. 

All  questions  of  the  competency  of  evidence  are  solved  hy 
the  Court  and  not  by  the  jury.^  The  facts  establishing  the 
privilege  are  presented  to  the  Court  for  its  consideration.  In 
Iowa  it  has  been  held  that  a  fair  trial  demands  that  it  should 
not  be  made  to  appear  to  the  jury  in  an  action  that  the  patient 
is  reluctant  to  waive  his  privilege,  and  that  therefore  the  sub- 
ject-matter of  waiver  has  no  place  in  the  taking  of  testimony 
except  when  introduced  by  the  party  permitted  to  make  it,  and 
the  Court  should  not  allow  the  patient  to  be  asked  to  answer 
under  oath  whether  he  is  willing  to  waive  his  privilege.^ 

Whether  it  is  the  duty  of  the  Court  to  enforce  the  privilege 
where  it  is  apparent  and  the  patient  is  not  present  to  object,  is 
a  question  that  seems  to  be  variously  regarded.  In  Indiana  a 
court  has  refused  a  new  trial  for  newly  discovered  evidence  of 
the  privileged  sort,  on  the  ground  that  if  objection  were  made 
on  the  new  trial  it  would  be  rejected.^  But  where  the  evidence 
of  a  physician  to  contradict  another  physician,  who  was  witness 
to  a  will,  was  received  without  objection,  it  was  said  that  it 
should  not  be  withdrawn  by  the  Court  from  the  consideration 
of  the  jury  or  its  value  commented  on  as  matter  of  law.* 

In  Michigan,  it  has  been  said  that  a  commissioner,  whose 
ordinary  duty  is  to  take  all  evidence  offered,  should  refuse  to 
take  this  privileged  evidence ;  and  that  it  should  be  stricken  out 

1  Brown  v.  R.  W.  &  O.  R.  R.  Co.,  •*  McConnell  v.  City  of  Osage,  45 
45  Hun,  439  (Supr.  Ct.,  Gen.  T.).  N.  W.  Rep.,  550. 

2  In   matter  of  O'Neil,    26  N.  Y.  ^  Harris  v.  Rnpel,  14Ind.,  209. 
St.  Rep.,  342  (N.  Y.  Surr.,  1889) .  «  Van  Valkenberg  v.  Van  Valken- 

3  Taylor,     Ev.,    s.    2;    Greenleaf,  berg,  90  Ind.,  433. 
Ev.,  s.  2. 


THE  PROVINCE  OF  THE  COURT.  129 

without  motion  bj^  the  judge  when  returned  by  the  commissioner, 
and  that  the  physician  should  not  be  allowed  to  violate  the  priv- 
ilege. '  It  has  also  been  held  that  an  order  for  the  compulsory 
physical  examination  of  a  person  by  a  physician  for  the  purpose 
of  testifying  should  not  be  granted,  and  that  evidence  so  obtained 
should  be  stricken  out,  but  on  the  ground  that  it  was  a  violation 
of  personal  liberty,  rather  than  of  statutory  privilege.^ 

But  in  New  York  it  has  been  held  that  where  a  person  vol- 
untarily in  an  action  exhibits  an  injured  part  as  evidence,  the 
adverse  party  is  entitled  to  follow  it  up  by  a  personal  or  profes- 
sional inspection  of  the  injured  part.' 

In  Missouri,  it  has  been  said  that  the  physician  should  be 
told  that  he  is  not  at  liberty  to  testify  as  to  ])rivileged  informa- 
tion.^ 

In  New  York,  in  an  early  case  in  chancery,  the  chancellor 
said  that  a  master  was  wrong  in  supposing  there  was  legal  evi- 
dence before  him,  where  a  phj^sician  had  given  evidence  privi- 
leged under  the  statute ;  ^  but  this  decision  was  reversed  on  ap- 
peal, the  Court  of  Errors  saying  that  as  no  objection  was  made 
before  the  master  by  a  partj",  the  evidence  was  competent  and 
legal."  This  question  seems  to  have  been  settled  in  New  York 
by  the  decision  in  Hoyt  v.  Hoy f, ''  tliEit  the  law  does  not  prohibit 
the  examination  of  a  physician  but  it  prohibits  the  evidence  be- 
ing received  in  the  face  of  objection,  so  that  if  no  objection  is 
made  by  a  party  it  is  not  the  province  of  the  Court  to  reject  the 
evidence. 

Where  it  appears  that  privileged  information  was  improperly 
admitted,  it  is  not  ground  for  reversal  on  appeal  if  it  is  appar- 
ent that  the  appellant  was  not  injured  by  its  reception.* 

Where  the  Court  is  not  empowered  to  reject  the  evidence  of 

'  Storrs   V.    Scougale,    48    Mich.,  ■»  Lunz  D.  Mass.  Mut.  L.  I.  Co.,  8 

387;   see  also  Dolton  v.  Albion,  24  Mo.  App.,  363. 

N.  W.  Rep..  786.  ^  Jolmson  v.  Johnson,  4  Paige,  460 

-Page  V.  Page,  41  Mich.,  88;  see  (Chancery,  1834)  ;  see  also  Hanford 

also  McQuigan  v.  D.  &  L.  R.  R.  Co.,  v.  Hanford,    3  Edw.  Ch.,  468  (Vice 

129  N.  Y.,   50;  Roberts  v.  Ogdens-  Chan.,  1841). 

burgh,  etc.,  Ry.  Co.,  29  Hun,   158;  «  14  Wend.,    636   (Ct.   of   Errors. 

McSwyny  v.  Broadway  &  8.  A.  Ry.  1835) . 

Co.,   7  N.   Y.    Supp.,   459;  and  cf.  '  112  N.  Y.,  493. 

N.    Y.    Code  Civ.   Pro.,  s.   873,  as  -*  Edingtoij  v.  yEtua  L.  I.  Co..  17 

amended  Act  1893,  c.  723.  W.  D.,  1883  (N.  Y.  Supr.  Ct.,  Gen. 

■^Winner    v.    Lathrop,    67    Hun,  T.)  ;    Hoyt  v.    Hoyt,    9  N.   Y.   St. 

511.  Rep.,   731   (Supr.  Ct.,  Gen.  T.),  af- 
firmed 112  N.  Y.,  493. 
9 


130  CONFIDENTIAL  COMMUNICATIONS — BOSTON. 

its  own  motion,  the  objection  upon  which  it  can  reject  is  the 
objection  of  a  party  to  the  suit,  and  doubtless  of  the  patient, 
but  not  of  the  physician.'  But  because  of  the  privilege,  it  has 
been  held  that  a  phj^sician  will  not  be  ordered  to  turn  over  his 
books  of  account  to  a  receiver  appointed  in  proceedings  supple- 
mentary to  an  execution  on  a  judgment  against  him.^  Nor 
will  examination  of  his  books  of  account  before  trial  be  com- 
pelled/ 

It  is  the  province  of  the  courts,  however,  to  enforce  the  law 
and  not  to  legislate  b}^  grafting  exceptions  upon  it."  They  have 
refused  therefore  to  except,  by  judicial  decision,  from  the  opera- 
tion of  the  law,  criminal  proceedings,  testamentary  causes,  evi- 
dence' of  crime  in  civil  actions,  cases  of  lunacy  and  habitual 
drunkenness  and  fraud, ^  in  all  of  which  it  was  urged  in  argu- 
ment without  effect  that  the  administration  of  justice  was  im- 
peded by  the  privilege;  but  where  the  spirit  of  the  law  was 
violated  by  an  enforcement  of  its  letter  and  the  privilege  made 
a  cloak  to  shield  the  murderer  of  the  patient,  it  was  held  to  be 
inapplicable."  The  courts  have  also  refused  hj  mere  judicial 
decision  to  limit  the  privilege  to  the  life  of  the  patient.' 

THE  EFFECT  OF  ENFORCING  THE  PRIVILEGE. 

The  courts  are  not  warranted  in  admitting  incompetent  evi- 
dence in  order  to  prevent  the  failure  of  justice  by  the  exclusion 
of  the  privileged  testimony.  A  letter  written  by  a  physician  is 
inadmissible  as  evidence  of  the  privileged  facts  which  it  states  ;* 
and  a  certificate  of  the  cause  of  death,  required  by  law  to  be 
signed  by  the  physician  and  filed,  is  not  admissible  to  prove 
the  cause  of  death  in  an  action  in  which  the  physician  cannot 
testify.^ 

The  making  of  the  objection  does  not  raise  a  presumption 

'^  Johnson  v.  Jobnson,  14  Wend.,  Y.,  573;  Record'?;.  Village  of  Sara- 

636;    Babcock  v.   People,    15  Hun,  toga  Springs.  46  Hun,  448 ;  Lodert). 

347;  Valensin  v.  Valensin,  14  Pac.  Whelpley,  111  N.  Y.,  239. 

Eep.,87  (Supr.  Ct.  Cal.,  1887).  ^  Siqjra,  p.  101  et  seq. 

2  Kelly  V.  Levy,  8  N.   Y.    Supp.,  ^  Supra,  p.  101  et  seq. 

849  (G.  T.  N.  Y.  City  Ct.,  1890).  '  Sujira,  p.  10>7. 

^Mott  ■».    Consumers'   Ice  Co.,  3  ^  Grattan -y.  Nat.  L.  I.  Co.  of  U. 

Abb.   N.  C,  143  (N.  Y.  Com.  PL,  S.,  15  Hun,  74. 

Sp.  T.,  1877).  s  Buffalo   L.    T.    &  S.  D.  Co.  v. 

^Edington  v.  Mut.    L.   I.   Co.,  5  Knights  T.  &  M.  M.  Aid  Assn.,  126 

Hun,  1  ;  Renihan  v.  Dennin,  103  N.  N.  Y.,  450. 


THE   EFFECT   OF   ENFORCING  THE   PRIVILEGE,  131 

against  the  person  making  it.'  In  Iowa  it  has  been  held  that 
the  patient  should  not  be  interrogated  under  oath  as  to  whether 
or  not  he  will  waive  his  privilege,  for  the  jur}^  ought  not  to  be 
prejudiced  against  him  by  any  show  of  reluctance/  In  Michi- 
gan, however,  it  has  been  held  that  a  patient's  failure  to  pro- 
duce his  physician  as  a  witness  is  a  legitimate  fact  for  the 
jury  to  consider.^ 


THE  CHARACTER  AND   "WEIGHT  OF  THE  EVIDENCE  TO 
SUSTAIN  THE  OBJECTION. 

Where  the  objection  is  made,  the  burden  of  proof  to  estab- 
lish the  grounds  of  privilege  is  upon  the  person  objecting." 
In  Missouri  it  has  been  said  that  the  statement  of  the  physician, 
that  he  cannot  separate  his  impressions  received  in  his  relation 
of  physician  from  those  received  at  other  times,  is  not  in  itself 
sufficient  to  justify  the  exclusion  of  his  evidence ;  that  the  facts 
themselves  must  appear  to  the  Court,  and  it  might  be  developed 
on  proper  cross-examination  that  discrimination  could  be  made.  ^ 

But  it  would  seem  that  because  of  the  necessarily  delicate 
nature  of  the  inquiry,  to  avoid  disclosing  what  the  statute  for- 
bids, the  burden  is  overcome  with  slight  evidence,  and  infer- 
ences and  presumptions  are  freely  indulged  in  aid  of  the  privi- 
lege; for  instance,  where  the  physician  was  not  permitted  to 
answer  whether  he  did  converse  with  his  patient  about  an  in- 
jury, or  whether  he  made  an  examination  with  reference  to  it, 
it  was  urged  that  the  objection  was  prematurely  made,  but  it 
was  held  that  the  fact  that  the  patient  consulted  a  physician  on 
the  occasion  to  which  the  inquiry  related,  when  considered  with 
the  nature  of  the  questions,  justified  the  exclusion  in  the  absence 
of  other  proof.  °     But  the  physician  may  testify  that  he  did 

lEdin^ton  v.  Mtna  L.  I.  Co.,  13  Rep.,   706    (N.   Y.  Supr.  Ct.,    Gen. 

Huu,  543  ;  see  Grattau  v.  Nat.  L.  I.  T.)  ;  Henry  v.  N.  Y.,  L.  E.  &  W.  R. 

Co.  of  U.  S.,  15  Hun,  74.  R.  Co.,  57  Hun,  76  (N.  Y.  Supr.  Ct., 

nicConnell  v.  City  of  Osage,  45  Gen.  T.)  ;  Edington  v.  MirwL  L.  I. 

N.  W.  Rep.,  550.  Co.,    77   N.    Y.,    564;    Gartside    v. 

^Cooley  V.  Foltz,  48  N.  W.  Rep.,  Conn.  Mut.  L.  I.  Co.,  8  Mo.  App.. 

176.  592. 

•i  People  V.  Schuyler,  43  Hun,  88  *  Gartside i).  Conn.  Mut.  L.  I.  Co., 

(N.Y.  Supr.  Ct.,  Gen.  T.),  affirmed  8  Mo.  App.,  592. 

106  N.  Y.,  298  ;  Stowelly.  American  «  Feeny  v.  Long  Island  R.  R.  Co., 

Co-operative   Assn.,    23  N.   Y.  St.  116N.  Y.,  375. 


132  CONFIDENTIAL   COMMUNICATIONS — BOSTON. 

attend  his  patient  as  physician ; '  and  he  may  answer  the  ques- 
tion whether  the  information  was  necessary  to  enable  him  to 
act  in  his  professional  capacity ; '  for  while  his  testimony  on 
that  point  is  not  conclusive,  and  the  Court  uses  its  own  judg- 
ment in  reaching  a  determination,  his  testimony  is  competent 
evidence.  ^  He  may  also  testify  that  a  person  was  ill  and  was 
his  patient,  that  he  attended  as  physician,  and  he  can  state  when 
he  attended  and  how  many  times.* 

It  has  been  said  that  where  the  evidence  justifies  the  con- 
clusion that  information  regarding  the  patient  is  acquired 
while  attending  in  a  professional  capacitj^,  it  is  not  essential  to 
shoW  by  formal  proof  that  the  information  was  necessary.^ 


THE  RIGHTS  AND  DUTIES  OF  THE  PHYSICIAN  WITH  REF- 
ERENCE TO  THE  PRIVILEGE. 

The  privilege  established  by  law  is  a  rule  of  evidence,  and 
not  a  regulation  of  a  physician's  general  conduct  outside  of  a 
proceeding  in  which  rules  of  evidence  are  applicable.'  The 
courts  have,  however,  not  hesitated  to  intimate  that  it  is  a  phy- 
sician's duty  to  observe  the  same  secrecy  in  his  general  walk 
and  conversation. ' 

The  physician  maj''  testify  as  an  expert  on  hypothetical  ques- 
tions submitted  to  him  regarding  facts  which  might  be  equally 
true  of  any  other  person  than  his  patient,  and  excluding  from 
his  consideration  privileged  knowledge.*  And  he  may  also 
testify  as  to  matters  which  came  to  his  knowledge  before  or 
after  or  independent  of  his  employment  as  physician,^  or  which 
were  immaterial  to  his  acting  in  a  professional  capacity,  and  as 

»  Numirich  v.  Supr.  Lodge  K.  &  «  Buffalo  L.  T.  &  S.  D.  Co.  v.  K. 

L.  of  H.,  3  N.  Y.  Supp.,  553  (Trial  T.  &  Mas.    3Iut.    Aid  Assn.,  126  N. 

Term,  City  Ct.  of  N.  Y.,  1889)  ;  see  Y.,  450. 

also  supra,  p.  115.  ''  Harris  v.    Rupel,   14  Ind.,  209; 

^  Herrington  v.    Winn,    60  Hun,  Sullings  v.  Shakespeare,  46  Mich., 

235  (Supr.  Ct.,  Gen.  T.,  1891).  408;  Storrs  v.  Scougale,  48  Mich., 

3  In  matter  of  Halsey,  29  N.  Y.  387  ;  Buffalo,  etc.,  Co.  v.  Knights T. 
St.  Rep.,  533  (N.  Y.  Surr.,  1890)  ;  &  Mas.  Mut.  Aid  Assn.,  126  N.  Y., 
of.  Matter  of  Darragh,  52  Hun,  591.  450. 

4  Patten  v.  United  L.  &  A.  Ins.  »  Corvell  v.  Stone,  62  Ind..  307; 
Assn.,  133  N.  Y.,  450.  People ^t;.  Schuyler.  43  Hun,  88,  af- 

5  Brigham  v.  Gott,  3  N.  Y.  Supp.,  firmed  106  N.  Y.,  298. 
518    (Supr.    Ct.,    Gen.    T.,    1889);  ^  Supra, -p.  123. 
supra,  p.  124. 


THE   RIGHTS   AND   DUTIES   OF   THE   PHYSICIAN.  133 

to  which  his  patient  could  have  had  no  reasonable  ground  for 
believing  that  they  were  necessarily  disclosed  in  order  that  the 
physician  might  so  act.'  It  is  the  patient's  privilege  and  not 
the  physician's;  and,  therefore,  the  physician  is  not  absolutely 
incompetent  as  a  witness,  and  has  no  right  to  refuse  to  testify." 
But  where  he  is  a  party  he  may  object  and  then  he  will  not  be 
forced  to  disclose  his  patient's  confidence.^ 

In  Indiana  it  has  been  held  that  where  the  patient  testifies 
in  an  action  against  his  physician  for  malpractice  the  phj'sician 
is  then  at  liberty  to  testify  or  to  introduce  any  other  witness  to 
testify  concerning  the  matters  in  controversy.^ 

In  Michigan,  a  physician  who  was  plaintiff  in  a  libel  suit 
was  not  permitted  to  insist  upon  the  privilege  to  prevent  the 
disclosure  of  his  maltreatment  of  his  patient  or  what  other 
physicians  had  discovered  with  regard  to  it  by  visits  to  his 
patients. ' 

The  measure  of  the  physician's  exemption  and  liability  in 
testifying  is  the  language  of  the  statute,  and  not  his  idea  of  his 
dutj^  to  his  patient  or  the  patient's  injunctions  of  confidence  or 
secrecy." 

In  some  of  the  States  there  are  statutory  provisions  entitling 
physicians  to  sue  for  compensation  for  their  professional  ser- 
vices.' The  statutes  regarding  privileged  communications  are 
to  be  construed  together  with  these.  There  seems  to  be  no 
reason  whj-  a  physician's  right  of  action  for  his  services  and 
medicines  should  not  survive  the  prohibition  of  his  evidence; 
but  it  would  seem  that  he  cannot  as  a  witness  in  such  an  action 
testify  regarding  privileged  matter.  But  he  can  prove  it  by 
other  witnesses.' 

'  Supra,  p.  119.  «  Grattant).  Metr.  L.  I.  Co..  SO  N. 

''Penn  Mut.   L.   I.  Co.  v.  Wiler,  Y.,  281. 

100  Ind.,  92.     Valeosint).  Valensin,  ''  See  p.  137,  this  volume,  for  tlie 

14  Pac.    Rep.,    87   (Supr.  Ct.    Cal.,  medical  laws  of  the  several  States 

1887)  ;  cf.  In  re  Hannah,  UN.  Y.  and  Territories  ;  for  history  of  pliy- 

St.  Rep.,  807.  sician's  right  of  action  for  services. 

^ Mason  v.  Libbey.  2  Abb.  N.  C,  see  Graham  v.    Gautier,    21    Tex., 

137;   Mott  V.  Consumers'  Ice  Co.,  2  117;  see  Wood  v.  Munson.  70  Hun. 

Abb.  N.  C,  143.  468.      In   Georgia  and    Alabama  a 

^Lane"?).  Boicourt,  27  N.  E.  Rep.,  physician's  books  are  evidence   in 

1111;  see  also  Winner  v.  Lathrop,  such  actions.     Code   Ala.,   18SG,   s. 

67 Hun,  511  (N.  Y.  Supr.  Ct.,  G.  T.) .  2,777  ;  Code  Ga.,  1882,  s.  3,777. 

"  Scripps  v.  Foster,  41  Mich.,  742.  *  Kendall  v.  Grey,  2  Hilt.,  300. 


134  CONFIDENTIAL  COMMUNICATIONS — BOSTON. 


THE  RESULT  OF  THE  LEGISLATION. 

It  is  doubtless  due  to  considerations  of  public  policy  that  the 
statutes  changing  the  common-law  rule  have  been  enacted;'  but 
they  have  not  proved  an  unalloyed  benefit,  and  some  of  their 
features  have  brought  about  conditions  which  in  some  cases  have 
embarrassed  the  administration  of  justice.  The  law  in  New  York 
ma}^  be  taken  for  illustration ;  it  formerly  cut  off  the  safest  means 
of  ascertaining  the  mental  condition  and  competency  of  a  testa- 
tor ;  ^  it  now  precludes  a  physician  from  disclosing  the  condition 
of  his  patient  who  is  a  lunatic  or  habitual  drunkard/  though  it 
be  the  most  satisfactory  evidence ;  it  shuts  out  much  testimony 
tending  to  show  fraud  in  insurance  cases  ;*  it  precludes  a  phy- 
sician from  stating  the  cause  of  his  patient's  death,  ^  though  there 
is  no  longer  any  secrecy  connected  with  it,  for  the  law  makes  it 
the  duty  of  the  phj^sician  to  make,  for  filing  with  the  local  board 
of  health,  a  certificate  of  the  probable  cause  of  the  death  of  a 
patient.^  It  has  been  the  subject  of  much  adverse  criticism,' 
but  all  such  considerations  are  properh'  to  be  addressed  to  the 
legislature  and  not  to  the  courts.  It  seems  to  be  the  most  far- 
reaching  in  its  exclusion,  and  though  it  has  been  the  longest  in 
existence,  was  modified  at  the  legislative  sessions  of  1891,  1892, 
and  1893,  a  fact  which  tends  to  show  that  there  was  sound 
reason  in  the  criticisms. 

'  Kling  V.  City  of  Kansas,  27  Mo.  certificates  of  the  fact  of  birth  for 

App.,  23i  ;  Pierson  ■«.  People,  79  N.  registration  (Act  1893,  c.  661,  sees. 

Y.,  424.  22,  31),  and  to  certifj^  the  existence 

'^  Suj)ra,  p.  103.     Matter  of  Cole-  of   contagious  and   infectious  dis- 

man,  111  N.  Y.,  220.  eases  (*.,  s.  24). 

3  Siqjra,  p.  103.  ''  See  suggestions  on  the  policy  of 

*  Siqwa,  p.  104.  the  New  York  law  in  Conn.   Mut. 

^  Supra,  p.  127.  L.  I.  Co.  v.  Union  Tr.  Co.,  112  U. 

«  Laws  of  N.  Y.,  Act  1893,  c.  661,  S.,  250  ;  Pearsall  v.  Elmer,  5  Redf., 

sees.  23,  31.     In  New   York  physi-  181 ;  and  contra,  Edington  v.  Mut- 

cians    are  also  required    to    attest  L.  I.  Co.,  5  Hun,  1. 


A  SYNOPSIS  OF  THE  LAWS 

OF   THE 

SEVERAL  STATES  AND  TERRITORIES   OF  THE   UNITED  STATES  OF 

AMERICA,  AND   OF   GREAT  BRITAIN  AND  IRELAND,   AND 

OF  THE  NORTH  AMERICAN  PROVINCES  OF  GREAT 

BRITAIN,  REGULATING  THE  PRACTICE 

OF   MEDICINE   AND   SURGERY, 

PEEPARED    FROM    THE    LATEST    STATUTES. 


BY 

WILLIAM   A.    POSTE, 

Late  First  Deputy  Attorne y-General  of  the  State  of  Neiv  York, 

AND 

CHARLES  A.  BOSTON,  Esq., 

of  the  Neto  York  City  Bar. 


SYNOPSIS  OF  THE  EXISTIE^G   STATUTES 

WHICH   REGULATE 

THE  ACaUIREMENT  OF  THE  RIGHT  TO  PRACTISE  MEDI- 
CINE AND  SURGERY  IN  THE  UNITED  STATES,  GREAT 
BRITAIN  AND  IRELAND,  AND  THE  CANADIAN  PROV- 
INCES. 

[Note. — This  synopsis  is  designed  to  contain  especially  those 
provisions  of  the  statutes  which  regulate  the  right  to  practise 
medicine  and  surgery.  It  is  not  intended  to  include  provisions 
regulating  apothecaries,  druggists,  chemists,  and  dentists,  or 
the  sale  of  drugs,  medicines,  and  poisons ;  nor  provisions  for  the 
organization  and  procedure  of  boards  of  medical  examiners,  ex- 
cept so  far  as  they  regulate  the  requirements  demanded  from 
applicants  for  permission  to  practise ;  nor  provisions  with  refer- 
ence to  the  duties  of  clerks  or  registrars  in  the  preparation  and 
safe-keeping  of  records  in  their  care;  nor  those  defining  the 
duties  of  members  of  boards,  and  punishing  the  misconduct  of 
such  members;  nor  those  prescribing  qualifications  for  appoint- 
ment to  the  public  medical  service ;  nor  former  laws  not  now 
applicable  to  candidates;  nor  regulations  of  the  form  of  cer- 
tificates or  licenses,  where  the  issuing  of  them  is  committed  to 
some  public  functionary  or  body ;  nor  provisions  with  reference 
to  the  powers  and  disabilities  of  local  institutions  to  confer 
diplomas  or  degrees,  nor  with  reference  to  medical  students  ex- 
cept as  candidates  for  admission  to  practise.  In  the  synopsis 
words  of  the  masculine  gender  are  uniformly  used  except  when 
the  law  by  its  terms  makes  a  distinction  between  men  and 
women,  in  which  case  the  distinction  is  indicated.] 

Alabama. 

Qualification. — The  board  of  censors  of  the  Medical  As- 
sociation of  the  State  of  Alabama  and  the  board  of  censors  of  the 
county  medical  societies  in  affiliation  with  the  said  association 
are  boards  of  medical  examiners  (Code  1887,  s.  1,301).  In  the 
absence  of  such  board  of  medical  examiners  in  any  county,  the 

137 


138  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

county  commissioners  may  establish  a  board  of  from  three  to 
seven  physicians  of  good  standing,  resident  in  the  county, 
whose  autliority  shall  terminate  whenever  a  board  is  organized 
in  accordance  with  the  constitution  of  and  in  affiliation  with 
said  association  {ib.,  s.  1,296).  Where  the  board  of  examiners 
is  constituted  as  provided  in  sec.  1,296,  it  must  issue  a  license 
to  practise  medicine  in  an}^  one  or  more  of  its  branches  in  the 
county,  if  on  examination  the  applicant  is  found  duly  qualified, 
and  is  of  good  moral  character  {ib.,  s.  1,297). 

In  a  county  having  only  the  medical  board  provided  for  in 
sec.  1,296,  a  regular  graduate  of  a  medical  college  in  the  United 
States,  having  a  diploma,  is  entitled  to  practise  medicine  with- 
out a  license,  upon  recording  his  diploma  in  the  office  of  the 
judge  of  probate  of  the  county  {ib.,  s.  1,298). 

A  license  issued  by  the  last-mentioned  board  must  be  re- 
corded in  the  office  of  the  judge  of  probate  of  the  county  {ib., 
s.  1,299).  The  license  or  diploma,  after  record,  is  evidence  of 
authority ;  if  the  original  be  lost,  a  certified  copy  of  the  record 
is  sufficient  evidence  {ib.,  s.  1,300).  Without  a  certificate  of 
qualification  from  the  board  provided  for  in  sec.  1,301,  except  as 
above  provided,  no  person  can  lawfully  practise  medicine  in 
any  of  its  branches  or  departments  as  a  profession  or  means  of 
livelihood  {ib.,  s.  1,302).  The  standard  of  qualification,  method 
or  system,  and  subjects  of  examination  are  prescribed  by  the 
medical  association  of  the  State  {ib.,  s.  1,303). 

The  board  of  medical  examiners,  on  application,  must  ex- 
amine an  applicant  for  a  certificate  of  qualification  as  a  practi- 
tioner of  medicine,  and  if  he  be  found  qualified,  and  of  good 
moral  character  must  issue  a  certificate  {ib.,  s.  1,304). 

Physicians  having  a  license  as  above  before  the  organization 
in  a  county  of  a  board,  are  on  application  thereto  entitled  to  a 
certificate  without  examination  and  to  be  registered  as  licensed 
practitioners  of  medicine  {ib.,  s.  1,305). 

The  certificate  is  a  license  throughout  the  State.  It  must 
be  recorded  in  the  office  of  the  judge  of  probate  of  the  county 
in  which  the  person  resides  at  the  time  of  issue.  Upon  record- 
ing it,  the  judge  must  indorse  a  certificate  of  record  and  sign 
it  and  affix  the  seal  of  the  court  {ib.,  s.  1,306).  Such  certificate, 
or,  if  lost,  a  certified  copj^  of  the  record,  is  evidence  {ib.,  s. 
1,307). 


ALABAMA — ARIZONA.  139 

Penalty. — A  contract  for  the  services  of  a  physician  or 
surgeon  is  void  unless  he  has  authority  to  practise ;  proof  of 
authority  is  not  required  at  trial  except  on  two  days'  notice  (^6., 
s.  1,318). 

Practising  medicine  or  surgery  without  a  certificate  is  a  mis- 
demeanor under  a  penalty  of  a  fine  of  from  $25  to  $100.  This 
provision  is  not  applicable  to  physicians  practising  medicine 
in  Alabama  in  1890,  who  are  graduates  of  a  respectable  medi- 
cal college  and  have  complied  with  the  law  by  having  their 
diplomas  recorded  by  the  judge  of  probate  in  the  county  where 
they  practise ;  nor  to  a  phj^sician  who  has  practised  in  the  State 
for  the  past  five  years  (Act  1890-91,  c.  376) ;  nor  to  women 
practising  midwifery  (Code  1887,  s.  1,308). 

Fees. — The  statutory  fees  are  as  follows: 

To  judge  of  probate,  for  record  of  diploma,  or  license  or 
certificate,  $1  {ib.,  s.  1,298,  1,299,  1,306). 

To  board  of  medical  examiners,  for  examination,  actual  ex- 
penses {ib.,  s.  1,304). 

Arizona, 

Qualification. — It  is  unlawful  for  any  person  to  practise 
medicine,  surgery,  or  other  obstetrics  unless  he  have  a  diploma 
regularly  issued  by  a  medical  college  lawfully  organized  under 
the  laws  of  the  State  wherein  it  is  located,  or  a  license  issued 
and  authorized  by  a  board  of  medical  examiners  under  and  by 
virtue  of  the  laws  of  any  State  or  Territory.  The  diploma  must 
state  that  the  person  named  is  qualified  to  practise  medicine  and 
surgery  in  all  of  its  departments  (Penal  Code,  1887,  s,  617,  as 
amended  Act  of  April  11th,  1893). 

A  diploma  granted  for  moneyed  consideration  or  other  arti- 
cle of  value  alone,  or  revoked  or  cancelled  by  the  college  by 
which  it  was  issued  or  by  act  of  the  legislature,  is  not  a  sufii- 
cient  qualification  {ib.,  s.  618). 

Every  practitioner  of  medicine,  surgery,  or  obstetrics  must 
register  in  the  county  recorder's  office  his  name,  residence,  and 
place  of  birth,  and  present  his  diploma  or  license,  and  the  county 
recorder  must  make  a  copy  of  it  under  the  record  of  his  name, 
residence,  and  place  of  birth.  The  person  registering  must  sub- 
scribe and  verify  an  affidavit  in  writing,  annexed  to  the  copy 


140  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

US  transcribed,  that  he  is  the  identical  person  named  in  the 
diploma  {ib.,  s.  G19,  as  amended  by  Act  of  April  11th,  1893). 

Definition,  Exception. — Any  person  is  regarded  as  prac- 
tising medicine  who  professes  publicly  to  be  a  physician  or  ha- 
bitually prescribes  for  the  sick,  or  appends  to  his  name  "  M.D.," 
but  the  act  does  not  prohibit  gratuitous  services  in  cases  of 
emergency ;  nor  apply  to  lawfully  commissioned  surgeons  and 
assistant  surgeons  of  the  United  States  armj-  and  those  who 
w  ere  commissioned  and  mustered  into  the  United  States  service 
in  the  great  rebellion,  or  physicians  or  surgeons  who  have  been 
in  active  practice  for  ten  years  and  at  least  three  years  in  the 
Territory",  nor  prevent  practice  and  receiving  pay  in  localities 
fifteen  miles  or  more  from  the  residence  or  office  of  a  regular 
phj'sician  {ib.,s.  620). 

Offence. — Violation  of  the  act  is  a  misdemeanor  {ib.,  s. 
621). 

Fees. — To  the  county  recorder,  for  registration,  85  {ib.,s. 
619). 

Arkansas.    ' 

Qualification. — It  is  unlawful  for  any  one  to  engage  in  the 
practice  of  medicine  and  surger}',  or  either,  as  a  calling  except 
as  provided  in  the  statute  (Act  April  14th,  1893,  s.  1). 

A  person  engaging  in  the  practice  of  medicine  or  surgery 
must  be  of  good  moral  character,  twenty-one  years  of  age,  and 
a  graduate  of  some  reputable  college  of  medicine  and  surgery 
that  requires  for  graduation  not  less  than  two  courses  of  lec- 
tures, each  in  a  different  year  {ib.,  s.  2). 

Before  engaging  in  practice,  such  person  must  exhibit  his 
diploma  to  some  county  clerk  of  the  State  and  have  it  recorded. 
The  clerk  must  give  him  a  certificate  of  record,  which  may  be 
attached  to  the  diploma  {ib.,  s.  3). 

In  all  cases  of  doubt  as  to  the  reputability  of  a  college,  it  is 
the  duty  of  the  cierk  of  the  county  court,  when  a  diploma  is 
offered  for  record,  to  make  inquiry  of  the  Secretary  of  the  State 
where  the  said  college  exists  as  to  its  reputability  and  require- 
ments for  graduation,  and  if  the  said  clerk  shall  find  that  the 
said  college  does  not  conform  to  the  requirements  of  this  article, 
he  shall  not  receive  the  diploma  and  the  holder  shall  not  be 
allowed  to  practise  in  the  State.     The  aggrieved  applicant  may 


ARKANSAS— CALIFORNIA.  141 

apply  to  the  State  board  of  medical  examiners,  whose  decision 
shall  govern  the  clerk  in  his  action  {ib.,  s.  4). 

If  after  recording  any  diploma  it  shall  come  to  the  knowl- 
edge of  the  clerk  making  the  record,  or  any  other  judicial  or 
executive  officer  of  the  State,  that  the  record  was  obtained  by 
fraud  or  misrepresentation,  it  shall  be  his  duty  to  institute 
before  the  said  court  of  record  proceedings  to  have  such  record 
reversed,  and  the  holder  of  the  diploma  shall  be  judged  guilty 
of  a  misdemeanor  {ib.,  s.  5). 

Exceptions. — The  act  does  not  affect  the  standing  of  any 
one  practising  at  the  time  of  its  passage  by  virtue  of  a  license 
under  the  then  existing  law,  nor  any  one  then  legally  engaged 
in  the  practice  of  medicine  and  surgery,  nor  does  it  prevent 
midwives  from  practising  their  calling  or  any  one  else  from 
giving  such  simple  domestic  remedies  as  they  are  in  the  habit 
of  using  (ib.,  s.  6). 

Examinations. — The  constituted  State  board  of  medical  ex- 
aminers is  authorized  to  examine  persons  having  no  diploma 
from  a  medical  college,  and  if  found  qualified  to  practise  med- 
icine and  surgery  issue  a  certificate  entitling  the  holder  to 
practise  in  this  State  {ib.,  s.  7). 

Systems,  Definition. — No  discrimination  of  schools  of 
medicine  is  allowed.  Any  person  who  prescribes  or  administers 
medicine  except  as  provided  in  sec.  6  is  deemed  a  physician 
{ib.,  s.  8). 

Penalty. — The  violation  of  this  act  is  a  misdemeanor  pun- 
ishable with  a  fine  of  from  $25  to  $100.  Each  day  of  practice 
is  a  separate  offence  {ib.,  s.  9). 

Date. — The  act  took  effect  ninety  days  after  its  passage  {ib., 
s.  10). 

Fees. — To  the  county  clerk,  for  recording,  $1.50. 

For  certificate  of  record  the  county  clerk  is  not  allowed  to 
charge  a  fee  {ib.,  s.  3). 

California. 

Qualification. — Every  person  practising  medicine  or  sur- 
gery in  any  of  its  departments  must  present  his  diploma  to  the 
board  of  examiners  with  affidavits.  If  the  board  finds  all  facts 
required   to  be  stated   in   the  affidavit  to  be  true,  it  issues  a 


143  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

certificate  conclusive  in  any  part  of  the  State  (Act  1877-78,  c. 
576;  amending  Act  1875-70,  c.  518). 

The  secretary  of  the  board  receives  applications.  The  board 
issues  certificates  to  all  who  furnish  satisfactory  proof  of  hav- 
ing received  diplomas  or  licenses  from  legally  chartered  medi- 
cal institutions  in  good  standing  (Act  1875-76,  c.  518,  s.  3). 

The  medical  society  of  the  State,  the  eclectic  medical  society 
of  the  State,  and  the  State  homoeopathic  medical  society  each 
appoint  annually  a  board  of  seven  examiners  who  must  be  regu- 
lar graduates  (Act  1877-78,  c.  576;  amending  Act  1875-76,  c. 
518). 

The  board  examines  diplomas  as  to  genuineness.  The  affi- 
davit accompanying  the  diploma  must  state  that  the  applicant 
is  its  lawful  possessor,  and  the  person  therein  named ;  that  the 
diploma  was  procured  in  the  regular  course  of  medical  instruc- 
tion and  without  fraud  or  misrepresentation  of  any  kind,  and 
that  the  medical  institution  granting  it  had,  at  the  time  of 
granting  the  same,  a  full  corps  of  medical  instructors,  and  was 
at  said  time  a  legally  incorporated  institution,  actually  and  in 
good  faith  engaged  in  the  business  of  medical  education,  and 
in  good  standing  as  a  medical  institution,  and  that  the  appli- 
cant had  complied  with  all  the  requirements  of  said  institution. 
The  affidavit  may  be  taken  before  any  person  authorized  to 
administer  oaths,  and  must  be  attested  under  the  hand  and 
official  seal  of  the  officer,  if  he  have  a  seal.  The  board  may 
hear  such  further  testimony  as  they  deem  proper  to  hear  as  to 
the  verification  of  the  diploma  or  the  identity  of  the  person,  or 
the  manner  in  which  the  diploma  was  procured,  and  if  it  ap- 
pears that  any  fact  stated  in  the  affidavit  is  untrue,  the  appli- 
cation is  rejected.  No  board  entertains  an  application  rejected 
by  another;  a  rejected  application  cannot  be  renewed  for  at 
least  one  year  {ib.,  s.  4,  as  amended  by  Act  1877-78,  c.  918) ;  no 
certificates  are  granted  except  to  persons  presenting  diplomas 
or  licenses  from  legally  chartered  medical  institutions  in  good 
standing  (ib.,  s.  5). 

Certificates  must  be  recorded  in  the  county  of  residence  and 
the  record  indorsed  thereon.  A  person  removing  to  another 
county  to  practise  must  procure  an  indorsement  to  that  effect 
on  his  certificate  from  the  county  clerk,  and  must  record  the 
certificate  in  the  county  to  which  he  removes  {ib.,  s.  6). 


CALIFORNIA.  143 

The  board  refuses  certificates  to  individuals  guilty  of  un- 
professional conduct.  The  applicant  is  given  an  opportunity  to 
be  heard,  by  citation ;  the  attendance  of  witnesses  may  be  com- 
pelled by  subpoena ;  witnesses  may  be  examined  at  the  hearing 
by  either  side,  and  either  side  may  examine  medical  experts  as 
to  whether  such  conduct  is  unprofessional ;  if  it  appears  to  the 
satisfaction  of  the  board  that  the  applicant  is  guilty  of  the 
unprofessional  conduct  set  out  in  the  citation,  no  certificate 
can  be  granted.  No  application  is  refused  for  unprofessional 
conduct  more  than  one  year  before  the  application.  If  the 
holder  of  a  certificate  is  guilty  of  unprofessional  conduct,  the 
certificate  must  be  revoked  by  board  granting  it;  no  revoca- 
tion is  valid  without  similar  proceedings  to  the  foregoing  (?'6., 
s.  10). 

Definition. — Any  person  is  regarded  as  practising  medicine 
who  professes  publicly  to  be  a  physician,  or  habitually  pre- 
scribes for  the  sick,  or  appends  to  his  name  "  M.D." 

Exceptions. — The  act  does  not  prohibit  gratuitous  services 
in  cases  of  emergency;  nor  apply  to  lawfully  commissioned 
surgeons  of  the  United  States  army  or  navy  practising  their 
profession  {ib.,  s.  11,  as  amended  1877-78,  c.  576). 

Itinerant  Venders. — A  license  of  $100  a  month  is  exacted 
from  itinerant  venders  of  drugs,  nostrums,  ointments,  or  ap- 
pliances for  treatment  of  disease,  and  from  persons  publicly  pro- 
fessing to  cure  or  treat  disease,  injury,  or  deformity  by  any 
medicine,  drug,  or  drugs,  nostrum,  manipulation,  or  other  ex- 
pedient (Act  1877-78,  c.  576,  amending  Act  1875-76,  c.  518, 
s.  12). 

Penalty. — The  penalty  for  violation  of  the  act  is  a  fine  of 
from  $50  to  $500,  or  imprisonment  in  the  county  jail  from  30 
to  365  days,  or  both,  for  each  and  every  offence.  Filing  or  at- 
tempting to  file  the  diploma  or  certificate  of  another,  or  a 
forged  afiidavit  of  identification,  is  a  felony,  punishable  the 
same  as  forgery  (ib.,  s.  13;  Act  1877-78,  c.  918,  s.  7). 

Former  Practitioners. — Holders  of  certificates  theretofore 
granted  by  the  board  of  examiners  existing  by  the  appointment 
of  the  California  State  Medical  Society  of  Homoeopatbic  Prac- 
titioners are  excused  b}^  the  Act  1877-78,  c.  918,  s.  7,  from  ob' 
taining  new  certificates. 

Rejected  Applicant. — A  certificate  issued  bj^  one  board 


144  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

to  an  applicant  rejected  by  another  within  a  3"ear  is  null  and 
void  (/6.,  s.  9). 

Fees. — To  secretary  of  board,  for  examining  genuine  di- 
ploma, $5. 

If  diploma  fraudulent  or  property  of  another,  $20  (Act 
1877-78,  c.  576,  s.  3;  amending  Act  1875-76,  c.  518,  s.  4). 

To  county  clerk,  for  recording  certificate,  usual  recording 
fees  (Act  1875-76,  c.  518,  s.  6). 

Colorado. 

Board  of  Examiners. — The  State  board  of  medical  ex- 
aminers is  composed  of  nine  practising  phj^sicians  of  known 
ability  and  integrity,  graduates  of  medical  schools  of  undoubted 
respectability,  six  of  the  regular  school,  two  of  the  homoeo- 
pathic, and  one  of  the  eclectic  school  or  system,  appointed  by  the 
governor  (Mills'  "Annotated  Statutes"  1891,  s.  3,547). 

Qualification. — Every  person  practising  medicine  must 
possess  the  required  qualifications.  If  a  graduate  in  medicine, 
he  must  present  his  diploma  to  the  State  board  of  medical  ex- 
aminers for  verification,  or  furnish  other  evidence  conclusive  of 
his  being  a  graduate  of  a  legally  chartered  medical  school  in 
good  standing.  The  board  issues  its  certificate,  and  such  diploma 
or  evidence  and  certificate  are  conclusive.  If  not  a  graduate  of 
a  legally  chartered  medical  school  in  good  standing,  the  person 
must  present  himself  before  the  board  for  examination.  AIL 
persons  who  have  made  the  practice  of  medicine  and  surgery 
their  profession  or  business  continuously  for  ten  years,  and 
can  furnish  satisfactory  evidence  thereof  to  the  State  medi- 
cal examiners,  shall  receive  a  license  to  continue  (z6.,  s. 
3,550). 

Examinations  of  persons  not  graduates  are  made  by  the 
State  board,  wholly  or  partly  in  writing,  in  anatomy,  physiol- 
ogy, chemistry,  pathology,  surgerj',  obstetrics,  and  practice  of 
medicine  (exclusive  of  materia  medica  -and  therapeutics)  (ib., 
s.  8,553). 

The  Jiolder  of  a  certificate  should  have  it  recorded  in  the 
office  of  the  clerk  of  the  county  in  which  he  resides,  and  the 
record  indorsed  thereon,  and  on  removing  to  another  county  to 
practise  should  procure  an  indorsement  to  that  effect  on  the  cer- 


COLORADO — CONNECTICUT.  145 

tificate  from  the  county  clerk,  and  record  this  certificate  in  the 
county  to  which  he  removes  {ib.,  s.  3,554). 

The  board  may  refuse  certificates  to  persons  convicted  of 
conduct  of  criminal  nature ;  and  may  revoke  certificates  for  like 
cause  {ib.,  s.  3,356). 

Definition. — Professing  publicly  to  be  a  physician  and 
prescribe  for  the  sick,  or  attaching  to  name  "M.D.,"  or  "sur- 
geon" or  "  doctor"  in  a  medical  sense,  is  regarded  as  practising 
medicine.  Gratuitous  services  in  case  of  emergency  are  not 
prohibited  {ib.,  s.  3,557). 

Penalty. — The  penalty  for  violation  of  the  act  is  a  fine  of 
from  $50  to  $300,  or  imprisonment  in  the  county  jail  from  ten 
days  to  thirty  days,  or  fine  and  imprisonment  for  each  offence ; 
filing  or  attempting  to  file  the  diploma  or  certificate  of  another, 
or  false  or  forged  evidence,  is  a  felony  punishable  the  same  as 
forgery  {ib.,  s.  3,558). 

System  of  Medicine. — Certificates  are  issued  without  prej- 
udice, partialitj',  or  discrimination  as  to  schools  or  systems  of 
practice  or  medicine,  including  the  electropathic  school  {ib.,  s. 
3,561). 

Pees. — To  treasurer  of  board  b}^  graduates  and  practitioners 
of  ten  years'  standing,  $5.  By  candidates  for  examination, 
$10  {ib.,  s.  3,552). 

To  county  clerk,  for  recording  certificate,  $1  {ib.,  s.  3,554). 

Connecticut. 

Qualification,  Exceptions. — After  October  1st,  1893, 
no  person  shall  for  comi^ensation,  gain,  or  reward,  received  or 
expected,  treat,  operate,  or  prescribe  for  any  injury,  deformity, 
ailment,  or  disease,  actual  or  imaginarj',  of  another  person,  nor 
practise  surgery  or  midwifery  unless  or  until  he  has  obtained 
a  certificate  of  registration,  and  then  only  in  the  kind  or  branch 
of  practice  stated  in  the  certificate,  but  the  act  does  not  apply 
to  dentists  practising  dentistry  only,  nor  to  any  person  in  the 
employ  of  the  United  States  Government  while  acting  in  the 
scope  of  his  employment,  nor  to  medical  or  surgical  assistance 
in  cases  of  sudden  emergency,  nor  to  any  person  residing  out 
of  the  State  who  shall  be  employed  to  come  into  the  State  to 
assist  or  consult  with  any  physician  or  surgeon  who  has  been 
10 


146  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

registered  in  conformity  with  the  act,  nor  to  any  physician  or 
surgeon  then  actually  residing  out  of  the  State  who  shall  be 
employed  to  come  into  the  State  to  treat,  operate,  or  prescribe 
for  any  injury,  deformity,  ailment,  or  disease  from  which  any 
person  is  suffering  at  the  time  when  such  non-resident  phy- 
sician or  surgeon  is  so  employed,  nor  to  an 3^  actual  resident  of 
this  State  recommending  by  advertisement  or  otherwise  the 
use  of  proper  remedies  sold  under  trade-marks  issued  by  the 
United  States  Government,  nor  to  any  chiropodist  or  clair- 
voyant not  using  in  his  practice  any  drugs,  medicines,  or 
poisons,  nor  to  any  person  practising  the  massage  method  or 
Swedish  movement  cure,  sun  cure,  mind  cure,  magnetic  heal- 
ing, or  Christian  science,  nor  to  any  other  person  who  does  not 
use  or  prescribe  in  his  treatment  of  mankind  drugs,  poisons, 
medicine,  chemicals,  or  nostrums  (Act  1898,  c.  148,  s.  1). 

Anj^  resident  of  the  State  who,  at  the  time  of  the  passage  of 
the  act,  was  or  previously  had  been  actually  engaged  in  the 
State  in  the  practice  of  medicine,  surgery,  midwiferj^,  or  any 
alleged  practice  of  healing,  may,  before  October  1st,  1893,  file 
with  the  State  board  of  health  duplicate  statements  subscribed 
and  sworn  to  by  him  upon  blanks  furnished  by  said  board, 
giving  his  name,  age,  and  place  of  birth  and  present  residence, 
stating  whether  he  is  a  graduate  of  any  medical  college  or  not, 
and  of  what  college,  and  the  date  of  graduation,  and  if  practis- 
ing under  a  license  from  any  of  the  medical  societies  of  the 
State,  which  society  and  the  date  of  such  license  and  the  length 
of  time  he  has  been  engaged  in  practice  in  the  State,  and  also 
elsewhere,  and  whether  in  general  practice  or  in  a  special 
branch  of  medicine  or  surgery,  and  what  branch.  On  receipt  of 
such  statements,  the  board  shall  issue  a  certificate  of  registra- 
tion which  shall  state  the  kind  or  branch  of  practice  in  which 
he  is  engaged  {ih.,  s.  2). 

Any  person  who  shall,  subsequent  to  October  1st,  1893,  file 
with  said  board  such  duplicated  statements,  showing  that  he  is 
a  graduate  of  a  medical  college  recognized  as  reputable  by  any 
chartered  medical  society  of  the  State,  shall  receive  a  certificate 
of  registration  which  shall  state  the  kind  or  branch  of  practice 
in  which  the  person  named  therein  is  engaged  or  is  to  be  en- 
gaged {ih.^  s.  3). 

Any  person  residing  in  any  town  in  another  State  which 


CONNECTICUT.  147 

town  adjoins  the  boundary  line  of  Connecticut,  who  was  actu- 
ally engaged  in  such  town,  at  the  time  of  the  passage  of  the  act, 
in  the  practice  of  medicine,  surgery,  or  midwifery,  or  any 
branch  of  practice,  may  before  October  1st,  1893,  obtain  from 
the  said  board  a  like  certificate  on  filing  such  duplicated  state- 
ments also  showing  that  he  is  entitled  to  such  certificate  under 
this  section  (ib.,  s.  4). 

Except  as  above  provided,  no  person  shall  after  October  1st, 
1893,  obtain  a  certificate  of  registration  until  he  has  passed  a 
satisfactory  examination  before  a  committee  appointed  by  said 
board,  nor  until  he  has  filed  with  the  said  board  duplicate  cer- 
tificates as  aforesaid,  signed  by  a  majority  of  one  of  said  exam- 
ining commissioners,  stating  that  they  have  found  him  qualified 
to  practise  either  medicine,  surgery,  or  midwifery,  and  any 
person  filing  said  certificates  shall  receive  from  said  board  a 
certificate  of  registration  (ib.,  s.  5). 

The  State  board  of  health,  in  January,  1894,  is  to  appoint 
three  examining  commissions,  each  of  five  physicians  nomi- 
nated respectively  by  the  Connecticut  Medical  Society,  the  Con- 
necticut Homoeopathic  Medical  Society,  and  the  Connecticut 
Eclectic  Medical  Association,  and  recommended  by  the  said 
societies  respectively  as  persons  competent  to  serve  upon  the 
said  examining  commissions.  Appointments  are  to  be  made 
thereafter  from  time  to  time  by  similar  nominations  (ib.,  s.  6 
and  7). 

The  State  board  of  health  shall  designate  when  and  where 
the  commissions  shall  hold  examinations,  but  shall  call  a  meet- 
ing of  a  commission  within  thirty  days  after  the  receipt  of  an 
application  for  examination.  Applicants  shall  be  examined  in 
anatomy,  physiology,  medical  chemistry,  obstetrics,  hj-giene, 
surgery,  pathology,  diagnosis,  and  therapeutics,  including  prac- 
tice and  materia  medica.  Each  commission  shall  frame  its 
own  questions  and  conduct  its  examinations  in  writing,  and 
both  questions  and  answers  shall  be  placed  on  file  with  the 
board.  Each  applicant  may  choose  by  which  of  the  commis- 
sions he  will  be  examined. 

After  rejection  by  any  examining  commission,  the  appli- 
cant shall  not  be  eligible  to  examination  by  another  commission 
until  after  the  expiration  of  twelve  months  (ib.,  s.  8). 

On  the  receipt  of  duplicate  statements,  the  board  shall  trans- 


148  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

mit  one  of  them  with  a  duplicate  certificate  of  registration  to 
the  town  clerk  of  the  town  where  the  person  filing  the  state- 
ment resides,  and  if  he  does  not  reside  in  the  State  to  the  town 
clerk  of  the  town  in  the  State  nearest  to  his  place  of  residence, 
and  said  clerk  shall  record  the  same  and  return  them  to  the 
person  who  filed  them  with  the  board  (^6.,  s.  9). 

The  secretary  of  each  medical  society  shall  file  with  the  sec- 
retary of  the  State  board  of  health  a  list  of  medical  colleges  or 
institutions  recognized  as  legal  and  reputable  by  his  society  or 
all  of  such  secretaries  may  agree  upon  a  single  list,  and  such 
list  may  be  corrected  from  time  to  time  {ib.,  s.  10). 

Penalty. — The  violation  of  sec.  10  shall  be  a  misdemeanor, 
punishable  with  a  fine  of  from  $100  to  $300  for  the  first  offence, 
and  for  each  subsequent  offence  by  a  fine  of  from  $200  to  $500 
or  imprisonment  in  the  county  jail  for  from  thirty  to  ninety 
days,  or  both  {ib.,  s.  11);  swearing  falsely  to  a  statement  is 
perjury  {ib.,  s.  12). 

Fees. — To  the  State  board  of  health,  on  filing  statements  or 
certificates,  $2  {ib.,  s.  2,  3,  4,  5). 

To  examining  commission,  before  examination,  their  ex- 
penses not  exceeding  $10  {ib.,  s.  8). 

To  the  town  clerk,  by  State  board  of  health  out  of  the 
amount  paid  to  it,  for  recording,  25  cents  {ib.,  s.  9). 

Delaware. 

Qualification. — It  is  unlawful  to  practise  medicine  or 
surgery  without  a  license  (Laws  1887,  vol.  18,  c.  35,  s.  1,  as 
amended  by  Laws  1889,  vol.  18,  c.  548). 

The  medical  board  of  examiners  for  the  State  must  grant 
a  license  to  any  person  applying  therefor  who  shall  produce  a 
diploma  from  a  respectable  medical  college,  or  shall,  upon  full 
and  impartial  examination,  be  found  qualified  for  such  practice 
(Rev.  Stats.,  c.  47,  s.  3).  The  board  consists  of  as  many  fel- 
lows of  the  Medical  Society  of  Delaware  as  the  society  deems 
proper  {ib.,  s.  3). 

The  clerk  of  the  peace  of  a  county,  on  presentation  of  a 
license  issued  by  the  board  of  examiners  of  the  Homoeopathic 
Medical  Society  of  Delaware  State  and  Peninsula,  under  its 
corporate  seal,  signed  by  its  president  and  countersigned  by  its 


DELAWARE — DISTRICT   OF   COLUMBIA.  U9 

secretary,  or  of  the  license  provided  by  sec.  3,  c.  47,  of  the 
Revised  Statutes,  or  on  the  affidavit  of  a  person  that  he  or  she 
has  practised  medicine  or  surgery  for  eight  years  continuously 
in  the  State,  and  upon  such  person  registering  his  name,  the 
date  of  his  graduation  and  college  (if  a  graduate),  and  his  place 
of  intended  residence,  must  issue  a  license  {ib.,  s.  2). 

A  person  opening  a  transient  office  or  assigning  a  transient 
office  by  printed  or  written  advertisement,  must  comply  with 
the  foregoing  provisions  and  pay  special  license  fee  for  a  license 
good  only  for  one  year  (Laws  1887,  vol.  18,  c.  35,  s.  5). 

Penalty. — The  violation  of  this  law  is  a  misdemeanor 
punishable  by  a  fine  of  from  $100  to  S300  {ib.,  s.  7). 

Exceptions. — The  present  law  exempts  those  who  complied 
with  the  Act  of  April  19th,  1883,  and  also  regular  practitioners 
of  another  State  in  consultation  with  a  lawful  practitioner  of 
medicine  and  surgery  of  this  State  {ib.,  s.  4,  6). 

Fees. — To  clerk  of  the  peace,  for  issuing  license  to  practise, 
$10.50  (Laws  1887,  vol.  18,  c.  35,  s.  4).  For  issuing  annual 
license  for  revenue  of  the  State,  $10.50  (Laws,  vol.  13,  c.  117, 
as  aniended,  vol.  14,  c.  16). 

To  secretary  of  board,  for  license,  $10  (Rev.  Stats.,  c.  47,  s. 
5). 

A  license  fee  to  practise  medicine,  for  the  revenue  of  the 
State,  is  also  required  {ib.,  s.  8;  vol.  13,  c.  117,  as  amended, 
vol.  14,  Laws,  c.  16). 

District  of  Columbia. 

Registration. — It  is  the  duty  of  every  physician,  ac- 
coucheur, and  midwife  practising  medicine,  or  doing  business, 
to  register  at  the  office  of  the  board  of  health,  giving  full  name, 
residence,  and  place  of  business,  and  in  case  of  removal  from 
one  place  to  another  in  the  District  to  make  a  change  in  the 
register  (Regulation  of  Board  of  Health,  August  28th,  1874,  s. 
8,  legalized  by  resolution  of  Congress,  No.  25,  s.  2,  April  24th, 
1880). 

Violation. — The  violation  of  the  foregoing  provision  is 
punishable  by  a  fine  of  from  $25  to  $200  forevery  offence  {ib., 
s.  9). 

Qualification. — All  physicians  required  to  register  must 


150  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

do  SO  upon  a  license  from  some  chartered  medical  society  or  upon 
a  diploma  from  some  medical  school  or  institution  {ih.,  s.  11 
[First]). 

Florida. 

Boards  of  Examiners. — The  governor  appoints  a  board  of 
medical  examiners  for  each  judicial  circuit,  and  a  board  of 
homopopathic  examiners  for  the  State  (Rev.  Stats.,  1802,  s. 
801). 

The  circuit  board  is  composed  of  three  practising  physicians 
of  known  ability,  graduates  in  good  standing  of  a  medical  col- 
lege, recognized  by  the  American  Medical  Association,  residents 
of  the  circuit;  the  homoeopathic  board  is  composed  of  three 
practising  homoeopathic  physicians  of  known  ability,  graduates 
in  good  standing  of  a  medical  college  recognized  by  the  Amer- 
ican Institute  of  Homoeopathy  (/&.,  s.  802). 

Qualification. — It  is  the  duty  of  the  board  of  examiners 
to  examine  thoroughly  every  applicant,  upon  the  production 
of  a  medical  diploma  from  a  recognized  college,  upon  anatomy, 
physiology,  surgery,  gynaecology,  therapeutics,  obstetrics,  and 
chemistry,  but  no  preference  is  given  to  any  school  of  medicine ; 
and  it  is  the  duty  of  the  board  of  homoeopathic  medical  ex- 
aminers to  examine  thoroughly  every  applicant,  upon  the  pro- 
duction of  his  diploma  from  a  college  recognized  by  the  Amer- 
ican Institute  of  Homoeopathy,  on  anatomy,  physiology,  sur- 
gery, gynaecology,  materia  medica,  therapeutics,  obstetrics,  and 
chemistry,  but  no  preference  is  given  to  any  school  of  medi- 
cine (Rev.  Stats.,  1892,  s.  806). 

When  the  board  is  satisfied  as  to  the  qualifications  of  the 
applicant,  they  grant  a  certificate  which  entitles  him  to  prac- 
tise medicine  in  any  county,  when  recorded  {ih.,  s.  807). 
Any  two  members  of  the  board  may  grant  a  certificate.  Any 
member  vasij  grant  a  temporary  certificate,  upon  examination, 
until  the  next  regular  meeting,  at  which  time  the  temporary 
certificate  ceases  to  be  of  effect  (^Z).,  s.  808).  Before  he  shall 
be  entitled  to  practise,  the  certificate  must  be  recorded  in  the 
office  of  the  clerk  of  the  circuit  court  of  the  county  in  which  he 
may  reside  or  sojourn ;  and  the  clerk  must  certif}'  thereon, 
under  official  seal,  the  fact  and  date  of  the  record,  and  return 
the  certificate  {ih..,  s.  809). 


FLORIDA — GEORGIA.  151 

A  practitioner  engaged  in  the  practice  of  medicine  in  any 
department  prior  to  May  31st,  1889,  upon  the  production  of  a 
diploma  from  a  medical  college  recognized  by  the  American 
Medical  Association,  is  granted  a  certificate,  without  further 
examination  and  without  charge  (ib.,  s.  811). 

Exceptions. — This  act  is  not  applicable  to  persons  who  have 
complied  with  prior  laws,  nor  to  females  practising  mid- 
wifery, strictly  as  such.  No  other  person  shall  practise  med- 
icine in  any  of  its  branches  or  departments,  without  having 
obtained  and  recorded  a  certificate  (^6.,  s.  812). 

Penalty. — Practising  as  a  phj-sician  without  a  certificate 
is  punishable  by  imprisonment  not  exceeding  six  months,  or  a 
fine  not  exceeding  $200  (^6.,  s.  2,6G9). 

Fees. — To  clerk,  legal  fee  for  recording  {ib.,  s.  809). 

To  board,  $10  from  each  applicant  whether  certificate 
granted  or  not  {ib.,  s.  810). 

Georgia. 

The  Code  of  1882,  s.  1,409  (a)  as  amended  by  chap.  413, 
Laws  1882-83,  provides  that — 

Qualification. — No  person  is  to  practise  medicine,  unless 
he  was  theretofore  legally  authorized,  or  is  hereafter  authorized 
by  a  diploma  from  an  incorporated  medical  college,  medical 
school  or  university,  or  has  after  attending  one  or  more  full 
terms  at  a  regularly  chartered  medical  college,  been  in  active 
practice  of  medicine  since  the  year  18G6,  or  was  by  law  author- 
ized to  practise  medicine  in  1866,  and  by  compliance  with  the 
statute. 

Definition. — To  "  practise  medicine"  means  to  suggest, 
recommend,  prescribe,  or  direct,  for  the  use  of  any  person,  any 
drug,  medicine,  appliance,  apparatus,  or  other  agency,  whether 
material  or  not  material,  for  the  cure,  relief,  or  palliation  of 
any  ailment  or  disease  of  mind  or  body,  or  for  the  cure  or  relief 
of  any  wound,  fracture,  or  other  bodily  injury,  or  any  deform- 
ity, after  having  received  or  with  the  intent  of  receiving  there- 
for, either  directly  or  indirectly,  any  bonus,  gift,  or  compensation 
{ib.,s.  1,409  [?;]). 

Registration. — Every  person  now  lawfully  engaged  in 
practice  must  register  on  or  before  December  1st,  1881 ;  every 


152  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

person  hereafter  duly  qualified  shall,  before  commencing  to 
practise,  register  in  the  office  of  the  clerk  of  the  superior  court 
of  the  county  wherein  he  resides  and  is  practising,  or  intends  to 
practise,  his  name,  residence,  and  place  of  birth,  together  with 
his  authority ;  he  shall  subscribe  or  verify,  by  oath  or  affirma- 
tion, before  a  person  duly  qualified  to  administer  oaths  under 
the  laws  of  this  State,  an  affidavit  containing  such  facts,  and 
whether  such  authority  is  by  diploma  or  license,  and  the  date 
of  the  same,  and  by  whom  granted,  which  shall  be  exhibited 
to  the  county  clerk,  before  the  applicant  is  allowed  to  register, 
and  which,  if  wilfully  false,  is  punishable  as  false  swearing 
{ih.,  s.  1,409  [c]). 

Removal. — A  registered  physician  changing  his  residence 
from  county  to  county  must  register  in  the  clerk's  office  of 
the  county  to  which  he  removes  and  wherein  he  intends  to 
reside  and  to  practise  medicine  {ib.,  s.  1,409  [d]). 

Penalty. — The  violation  of  this  law  or  practising,  or  offer- 
ing to  practise,  without  lawful  authority,  or  under  cover  of  a 
diploma  or  license  illegally  obtained,  is  a  misdemeanor,  punish- 
able by  a  fine  of  from  $100  to  $500,  or  imprisonment  from  thirty 
to  ninety  days,  or  both  {ib.,  s.  1,409  [e]). 

Exceptions. — Commissioned  medical  officers  of  the  United 
States  army  or  navj-,  or  United  States  marine  hospital  service, 
and  women  practising  only  midwifery,  are  not  affected  {ih.,  s. 
1,409  [/]). 

Medical  Boards. — All  medical  boards  are  abolished,  and 
only  the  qualifications  of  practitioners  of  medicine  set  forth 
above  are  required  {ih.,  s.  1,409  [g']). 

Fees. — To  county  clerk,  fifty  cents  for  each  registration 
{ib.,  s.  1,409  [c]). 

Tax. — On  practitioners  of  physic,  $5  per  annum  {ib.,  s. 
809). 

Idaho. 

Qualification. — No  person  can  lawfully  practise  medicine 
or  surgery  who  has  not  received  a  medical  education,  and  a  di- 
ploma from  a  regularly  chartered  medical  school,  having  a  bona 
fide  existence  when  the  diploma  was  granted  (Rev.  Stats.,  188T, 
s.  1,298). 

A  physician  or  surgeon  must  file  for  record  with  the  county 


IDAHO — ILLINOIS.  153 

recorder  of  the  county  in  which  he  is  about  to  practise,  or  where 
he  practises,  a  copy  of  his  diploma,  at  the  same  time  exhibiting 
the  original,  or  a  certificate  from  the  dean  of  a  medical  school 
certifying  to  his  graduation  (ib.,  s.  1,298  [a]). 

When  filing  the  cop}^  required,  he  must  be  identified  as  the 
l^erson  named  in  the  papers,  by  the  affidavit  of  two  citizens  of 
the  county,  or  by  his  affidavit  taken  before  a  notary  public  or 
commissioner  of  deeds  for  this  State ;  and  the  affidavit  is  filed 
in  the  office  of  the  county  recorder  {ib.,  s.  1,298  [b]). 

Penalty. — Practising  without  complying  with  the  act  is  a 
misdemeanor,  punishable  by  a  fine  of  from  $50  to  $500,  or  im- 
prisonment in  a  county  jail  from  thirty  days  to  six  months,  or 
both  fine  and  imprisonment  for  each  offence. 

Filing  or  attempting  to  file  as  his  own  the  diploma  or  cer- 
tificate of  graduation  of  another,  or  a  forged  affidavit  of  identi- 
fication, is  a  felony;  subject  to  fine  and  imprisonment  {ib.,  s. 
1,298  [c];  ib.,  s.  6,312). 

Exceptions. — The  act  is  not  applicable  to  a  person  in  an 
emergency  prescribing  or  giving  advice  in  medicine  or  surgery, 
in  a  township  where  no  physician  resides  within  convenient 
distance,  nor  to  those  who  have  practised  medicine  or  surger}- 
in  this  State  for  ten  years  preceding  the  passage  of  this  act,  nor 
to  persons  prescribing  in  their  own  families,  nor  to  midwifery 
in  places  where  no  physician  resides  within  convenient  distance 
{ib.,  s.  1,298  [e] ;  as  amended  by  Act  of  February  7th,  1889). 

Fees. — No  special  fees  are  enumerated  in  the  statute.  The 
county  recorder's  fees  for  services  are  prescribed  in  Rev. 
Stats.,  1887,  s.  2,128. 

Illinois. 

Qualification. — No  person  can  lawfully  practise  medicine 
in  any  of  its  departments  unless  he  possesses  the  qualifications 
required*  If  a  graduate  in  medicine,  he  must  present  his  di- 
ploma to  the  State  Board  of  Health  for  verification  as  to  its 
genuineness.  If  the  diploma  is  found  genuine,  and  from  a  legally 
chartered  medical  institution  in  good  standing,  and  if  the  person 
named  therein  be  the  person  claiming  and  presenting  the  same, 
the  board  must  issue  a  certificate  conclusive  as  to  his  riglit  to 
practise  medicine.     If  not  a  graduate,  the  person  must  present 


154  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

himself  before  the  said  board  and  submit  to  examination,  and 
if  the  examination  is  satisfactory  the  board  must  issue  certifi- 
cate (Laws  1887,  p.  225,  s.  1). 

The  verification  of  a  diploma  consists  in  the  affidavit  of  the 
holder  and  applicant  that  he  is  the  person  therein  named.  The 
affidavit  may  be  taken  before  any  person  authorized  to  admin- 
ister oaths,  and  attested  under  the  hand  and  official  seal  of  such 
officer  (if  he  have  a  seal).  Swearing  falsely  is  perjury.  Grad- 
uates may  present  their  diplomas  and  affidavits  by  letter  or 
proxy  (^6.,  s.  3). 

All  examinations  of  persons  not  graduates  or  licentiates  are 
made  by  the  board ;  and  certificates  authorize  their  possessor  to 
practise  medicine  and  surgery  (/&.,  s.  4). 

The  certificate  must  be  recorded  in  the  office  of  the  clerk  of 
the  county  in  which  the  holder  resides  within  three  months 
from  its  date,  and  the  date  of  recording  indorsed.  Until 
recorded,  the  holder  cannot  lawfully  exercise  the  rights  and 
privileges  conferred.  A  person  removing  to  another  county  to 
practise  must  record  his  certificate  in  the  county  to  which  he 
removes  (f6,,  s.  5). 

Examinations  may  be  wholly  or  partly  in  writing  and  shall 
be  of  elementary  and  practical  character,  but  sufficiently  strict 
to  test  the  qualifications  of  the  candidate  as  a  practitioner  {ib., 
s.  8). 

The  board  may  refuse  to  issue  a  certificate  to  a  person  guilty 
of  unprofessional  or  dishonorable  conduct,  and  may  revoke  for 
like  causes.  The  applicant  in  case  of  a  refusal  or  revocation 
may  appeal  to  the  governor  and  his  decision  will  be  final  {ib., 
s.  9). 

Definition. — "  Practising  medicine"  is  defined  as  treating, 
operating  on,  or  prescribing  for  any  physical  ailment  of  another. 
The  act  does  not  prohibit  services  in  case  of  emergency,  nor  the 
domestic  administration  of  family  remedies,  and  does  not  apply 
to  commissioned  surgeons  of  the  United  States  army,  navj",  or 
marine  hospital  service  in  the  discharge  of  official  duty  {ib., 
s.  10). 

Itinerant  Vender. — An  itinerant  vender  of  drug,  nostrum, 
ointment,  or  appliance  intended  for  treatment  of  disease  or 
injury,  or  professing  by  writing,  printing,  or  other  method  to 
cure  or  treat  disease  or  deformity  by  drug,  nostrum,  manipula- 


ILLINOIS — INDIANA.  155 

tion,  or  other  expedient,  must  pay  a  license  fee  of  $100  per  month 
into  the  treasury  of  the  board.  The  board  may  issue  such 
license.  Selling  without  a  license  is  punishable  by  fine  of  from 
$100  to  $200  for  each  offence.  The  board  may  for  cause  refuse 
a  license  {ib.,  s.  11). 

Penalty. — Practising  medicine  or  surgery  without  a  cer- 
tificate is  punishable  by  a  forfeiture  of  $100  for  the  first  offence, 
and  $200  for  each  subsequent  offence ;  filing  or  attempting  to 
file  as  his  own  the  certificate  of  another,  or  a  forged  affidavit 
of  identification,  is  a  felony,  punishable  as  forgery. 

Exceptions. — The  act  saves  for  six  months  after  its  passage 
the  right  of  persons  who  have  practised  continuously  for  ten 
years  in  the  State  prior  to  its  passage,  to  receive  a  certificate 
under  former  act.  But  all  persons  holding  a  certificate  on 
account  of  ten  years'  practice  are  subject  to  all  requirements  and 
discipline  of  this  act  in  regard  to  their  future  conduct;  all 
persons  not  having  applied  for  or  received  certificates  within 
said  six  months,  and  all  persons  whose  applications  have  for 
the  causes  named  been  rejected,  or  their  certificates  revoked, 
shall,  if  they  practise  medicine,  be  deemed  guilty  of  practising 
in  violation  of  law  {ib.,  s.  12). 

Penalty. — On  conviction  of  the  offence  mentioned  in  the 
act,  the  court  must,  as  a  part  of  the  judgment,  order  the 
defendant  to  be  committed  to  the  county  jail  until  the  fine  and 
costs  are  paid  {ib.,  s.  13). 

Fees. — To  the  secretary  of  the  board,  for  each  certificate  to 
a  graduate  or  licentiate,  $5  {ib.,  s.  2). 

For  graduates  or  licentiates  in  midwifery,  $2  {ib.,  s.  2). 

To  county  clerk,  usual  fees  for  making  record. 

To  treasury  of  board,  for  examination  of  non-graduates: 
$20,  in  medicine  and  surgery;  $10,  in  midwifery  only. 

If  the  applicant  fails  to  pass,  the  fees  are  returned.  If  he 
passes,  a  certificate  issues  without  further  charge  {ib.,  s.  7). 

Indiana. 

Qualification. — It  is  unlawful  to  practise  medicine,  sur- 
gery, or  obstetrics  without  a  license  (Act  April  11th,  1885, 
s.l). 

The  license  is  procured  from  the  clerk  of  the  circuit  court  of 


156  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

the  county  where  the  person  resides  or  desires  to  locate  to  prac- 
tise ;  it  authorizes  him  to  practise  anywhere  within  the  State ; 
the  applicant  must  file  with  the  clerk  his  affidavit  stating  that 
he  has  regularly  graduated  in  some  reputable  medical  college, 
and  must  exhibit  to  the  clerk  the  diploma  held  by  him,  his 
affidavit,  and  the  affidavit  of  two  reputable  freeholders  or  house- 
holders of  the  county  stating  that  the  applicant  has  resided  and 
practised  medicine,  surgerj^,  and  obstetrics  in  the  State  contin- 
uously for  ten  years  immediately  preceding  the  date  of  taking- 
effect  of  this  act,  stating  particularly  the  locality  or  localities 
in  which  he  has  practised  during  the  said  period,  and  the  date 
and  length  of  time  in  each  locality ;  or  his  affidavit  and  the 
affidavit  of  two  reputable  freeholders  or  householders  of  the 
county,  stating  that  he  has  resided  and  practised  medicine, 
surgery,  and  obstetrics  in  the  State  continuously  for  three 
years  immediately  preceding  the  taking  effect  of  this  act,  and 
stating  particularly  the  localities  in  which  he  practised  during 
the  said  period,  and  the  date  and  length  of  time  in  each  locality, 
and  that  he,  prior  to  said  date,  attended  one  full  course  of 
lectures  in  some  reputable  medical  college.  The  clerk  must 
record  the  license  and  the  name  of  the  college  in  which  the 
applicant  graduated,  and  the  date  of  his  diploma  {ib.,  s.  2,  as 
amended  by  Act  March  9th,  1891). 

A  license  issued  to  a  person  who  has  not  complied  with  the 
requirements  of  sec.  2,  or  one  procured  by  anj'  false  affidavit,  is 
void  (Act  April  11,  1885,  s.  3). 

Penalty. — Practising  medicine,  surgery,  or  obstetrics  with- 
out a  license  is  a  misdemeanor  punishable  with  a  fine  of  from 
$10  to  $200  {ib.,  s.  4). 

No  cause  of  action  lies  in  favor  of  any  person  as  a  physician, 
surgeon,  or  obstetrician  who  has  not  prior  to  the  service  pro- 
cured a  license;  and  money  paid  or  property  paid  for  such 
services  to  a  person  not  so  licensed,  or  the  value  thereof,  may 
be  recovered  back  {ib.,  s.  5). 

Exemptions. — Women  practising  obstetrics  are  exempted 
from  the  provisions  of  the  act  {ib.,  s.  4). 

Fees. — To  clerk,  for  license,  $1.50  (Act  April  11th,  1885,  as 
amended  Act  March  9th,  1891). 

Registration. — It  is  the  duty  of  all  physicians  and  ac- 
coucheurs to  register  their  name  and  post-office  address  with 


INDIANA — IOWA.  157' 

* 

the  clerk  of  the  circuit  court  of  the  county  in  which  they  reside 
(Act  1881,  p.  37,  s.  10). 

Fees. — To  the  clerk,  for  registration,  10  cents  (ib.,  s.  11). 

Iowa. 

Qualification. — Every  person  practising  medicine,  sur- 
gery, or  obstetrics,  in  any  of  their  departments,  if  a  graduate  in 
medicine,  must  present  his  diploma  to  the  State  board  of  ex- 
aminers for  verification  as  to  its  genuineness.  If  the  diploma 
is  found  genuine,  and  is  by  a  medical  school  legally  organized 
and  of  good  standing,  which  the  board  determines,  and  if  the 
person  presenting  be  the  person  to  whom  it  was  originally 
granted,  then  the  board  must  issue  a  certificate  signed  by  not 
less  than  five  phj^sicians  thereof,  representing  one  or  more  phy- 
sicians of  the  schools  on  the  board  (sic),  and  such  certificate  is 
conclusive.  If  not  a  graduate,  a  person  practising  medicine 
or  surgery,  unless  in  continuous  practice  in  this  State  for  not 
less  than  five  years,  of  which  he  must  present  to  the  board  sat- 
isfactory evidence  in  the  form  of  affidavits,  must  appear  be- 
fore the  board  for  examination.  All  examinations  are  in  writ- 
ing; all  examination  papers  with  the  reports  and  action  of 
examiners  are  preserved  as  records  of  the  board  for  five  years. 
The  subjects  of  examination  are  anatomy,  physiology,  general 
chemistry,  pathology,  therapeutics,  and  the  principles  and 
practice  of  medicine,  surgery,  and  obstetrics.  Each  applicant, 
upon  receiving  from  the  secretary  of  the  board  an  order  for 
examination,  receives  also  a  confidential  number,  which  he 
must  place  upon  his  examination  papers  so  that,  when  the  papers 
are  passed  upon,  the  examiners  may  not  know  by  what  ap- 
plicant they  were  prepared.  Upon  each  day  of  examination 
all  candidates  are  given  the  same  set  or  sets  of  questions. 
The  examination  papers  are  marked  on  a  scale  of  100.  The  ap- 
plicant must  attain  an  average  determined  by  the  board ;  if 
such  examination  is  satisf actor}''  to  at  least  five  physicians 
of  the  board,  representing  the  different  schools  of  medicine  on 
the  board,  the  board  must  issue  a  certificate,  which  entitles  the 
lawful  holder  to  all  the  rights  and  privileges  in  the  act  provided 
(Laws  1886,  c.  101,  s.  1). 

The  board  receives  applications  through  its  secretary.     Five 


158  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

physicians  of  the  board  may  act  as  an  examining  board  in  the 
absence  of  the  full  board ;  provided  that  one  or  more  members 
of  the  different  schools  of  medicine , represented  in  the  State 
board  of  health  shall  also  be  represented  in  the  board  of  exam- 
iners {lb.,  s.  2). 

The  affidavit  of  the  applicant  and  holder  of  a  diploma  that  he 
is  the  person  therein  named,  and  is  the  lawful  possessor  there- 
of, is  necessary  to  verify  the  same,  with  such  other  testimony 
as  the  board  may  require.  Diplomas  and  accompanying  affi- 
davits may  be  presented  in  person  or  by  proxy.  If  a  diploma 
is  found  genuine  and  in  possession  of  the  person  to  whom  it 
was  issued,  the  board,  on  payment  of  the  fee  to  its  secretary, 
must  issue  a  certificate.  If  a  diploma  is  found  fraudulent  or 
not  lawfully  in  possession  of  the  holder  or  owner,  the  person 
presenting  it,  or  holding  or  claiming  possession,  is  guilty  of  a 
misdemeanor,  punishable  with  a  fine  of  from  $20  to  $100  {ib., 
s.  3). 

The  certificate  must  be  recorded  in  the  office  of  the  county 
recorder  in  the  county  wherein  the  holder  resides,  within  sixty 
days  after  its  date.  Should  he  remove  from  one  count}'  to  an- 
other to  practise  medicine,  surgery,  or  obstetrics,  his  certificate 
must  be  recorded  in  the  count}^  to  which  he  removes.  The 
recorder  must  indorse  upon  the  certificate  the  date  of  record 
(ib.,  s.  4). 

Any  one  failing  to  pass  is  entitled  to  a  second  examination 
within  twelve  months  without  a  fee ;  any  applicant  for  exam- 
ination, by  notice  in  writing  to  the  secretary  of  the  board,  is 
entitled  to  examination  within  three  months  from  the  time  of 
notice,  and  the  failure  to  give  such  opportunity  entitles  such 
applicant  to  practise  without  a  certificate  until  the  next  regular 
meeting  of  the  board.  The  board  may  issue  certificates  to 
persons  who,  upon  application,  present  a  certificate  of  having 
passed  a  satisfactory  examination  before  any  other  State  board 
of  medical  examiners,  upon  the  payment  of  the  fee  provided  in 
sec.  3  (ib.,  s.  6,  as  amended  c.  66,  Laws  1888,  22  Gen.  As- 
sembly). 

The  board  may  refuse  a  certificate  to  a  person  who  has  been 
convicted  of  felony  committed  in  the  practice  of  his  profession, 
or  in  connection  therewith;  or  may  revoke  for  like  cause,  or 
for  palpable  evidence  of  incompetency,   and  such   refusal  or 


IOWA.  159 

revocation  prohibits  such  person  from  practising  medicine,  sur- 
gery, or  obstetrics,  and  can  onl}'  be  made  with  the  affirmative 
vote  of  at  least  five  physicians  of  the  State  board,  in  which  must 
be  inchided  one  or  more  members  of  the  different  schools  of 
medicine  represented  in  the  said  board;  the  standing  of  a 
legallj"  chartered  medical  college  from  which  a  diploma  may  be 
presented  must  not  be  questioned  except  by  a  like  vote  {ib., 
s.  7). 

Definition,  Exceptions. — Any  person  is  deemed  practis- 
ing medicine,  surger}-,  or  obstetrics,  or  to  be  a  physician,  who 
publicly  professes  to  be  a  physician,  surgeon,  or  obstetrician,  and 
assumes  the  duties,  or  who  makes  a  practice  of  prescribing,  or 
prescribing  and  furnishing  medicine  for  the  sick,  or  who  pub- 
licly professes  to  cure  or  heal  by  any  means  whatsoever ;  but  the 
act  does  not  prohibit  students  of  medicine,  surgery,  or  obstetrics 
from  prescribing  under  the  supervision  of  preceptors  or  gratui- 
tous services  in  case  of  emergency ;  nor  does  it  appl}'  to  women 
at  the  time  of  its  passage  engaged  in  the  practice  of  midwifery, 
nor  does  it  prevent  advertising,  selling,  or  prescribing  natural 
mineral  waters  flowing  from  wells  or  springs,  nor  does  it  apply 
to  surgeons  of  the  United  States  army,  navy,  or  marine  hospital 
service,  nor  to  physicians  defined  therein  who  have  been  in  prac- 
tice in  this  State  for  five  consecutive  years,  three  years  of  which 
must  have  been  in  one  locality,  provided  such  physician  shall 
furnish  the  State  board  with  satisfactory  evidence  of  such  prac- 
tice and  shall  procure  a  proper  certificate,  nor  to  registered 
pharmacists  filling  prescriptions,  nor  does  it  interfere  with  the 
sale  of  patent  or  proprietary  medicines  in  the  regular  course 
of  trade  {ib.,  s.  8). 

Penalty. — A  person  practising  medicine  or  surgery  with- 
out complying  with  the  act,  and  not  embraced  in  the  exceptions, 
or  after  being  prohibited  as  provided  in  sec,  7,  is  guilty  of  a 
misdemeanor  punishable  with  a  fine  of  from  $50  to  $100,  or 
imprisonment  in  the  county  jail  from  ten  to  thirtj^  days  {ib., 
s.  9). 

Filing  or  attempting  to  file  as  one's  own  the  diploma  of 
another,  or  the  certificate  of  another,  or  a  dijjloma  or  certificate 
with  the  true  name  erased  and  the  claimant's  name  inserted, 
or  a  forged  affidavit  of  identification,  is  forgery  {ib.,  s.  10). 

Fees. — To  count)^  recorder,  50  cents  {ib.,  s.  4). 


IGO  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

To  State  board,  for  certificate  to  holder  of  diploma,  $^  {ib., 
s.  3). 

To  secretary  of  State  board,  in  advance,  by  candidate  for  ex- 
amination, $10  (lb.,  s..  0). 

By  practitioner  for  five  years,  $2  {ib.,  s.  8). 


Kansas. 

Qualification. — it  is  unlawful  for  a  person  who  has  not 
attended  two  full  courses  of  instruction  and  graduated  in  some 
respectable  school  of  medicine,  either  of  the  United  States  or  of 
some  foreign  countrj',  or  who  cannot  produce  a  certificate  of 
qualification  from  some  State  or  county  medical  society,  and  is. 
not  a  person  of  good  moral  character,  to  practise  medicine  in 
any  of  its  departments  for  reward  or  compensation,  for  any  sick 
person ;  provided  in  all  cases  when  any  person  has  been  con- 
tinuously engaged  in  practice  of  medicine  for  ten  years  or  more, 
he  shall  be  considered  to  have  complied  with  the  provisions  of 
the  act  (Gen.  Stats.,  1889,  s.  2,450). 

Penalty, — Practising  or  attempting  to  practise  medicine 
in  any  of  its  departments  or  performing  or  attempting  to  per- 
form any  surgical  operation  in  violation  of  the  foregoing  is 
punishable  with  a  fine  of  from  $50  to  $100;  and  a  second  viola- 
tion, in  addition  to  a  fine,  is  punishable  with  imprisonment  in 
the  county  jail  for  thirty  days ;  and  in  no  case  wherein  the  act 
is  violated  shall  the  violator  receive  a  compensation  for  services 
rendered  {ib.,  s.  2,451). 

Kentucky. 

Qualification. — It  is  unlawful  for  any  person  to  practise 
medicine  in  any  of  its  branches  who  has  not  exhibited  and 
registered  in  the  county  clerk's  office,  in  the  county  in  which 
he  resides,  his  authority  to  practise,  with  his  age,  address,  place 
of  birth,  and  the  school  or  system  of  medicine  to  which  he  pro- 
poses to  belong.  The  person  registering  must  subscribe  and 
verify  bj^'oath  before  such  clerk  an  aflSdavit  containing  such 
facts,  which,  if  wilfully  false,  subjects  the  affiant  to  punish- 
ment for  perjury  (Act  1893,  April  10th,  s.  2). 


KANSAS — KENTUCKY.  161 

Authority  to  practise  shall  be  a  certificate  from  the  State 
board  of  health  issued  to  any  reputable  physician  who  is  prac- 
tising, or  who  desires  to  begin  to  practise,  who  possesses  a 
diploma  from  a  reputable  medical  college  legally  chartered 
under  the  laws  of  this  State,  or  a  diploma  from  a  reputable  and 
legally  chartered  medical  college  of  some  other  State  or  countrj'-, 
indorsed  as  such  by  said  board,  or  satisfactory  evidence  from 
the  applicant  that  he  was  reputably  and  honorablj^  engaged  in 
the  practice  of  medicine  in  the  State  prior  to  February  23d, 
18G4,  Applicants  may  present  their  credentials  by  mail  or 
proxy  [ib.,  s.  3). 

Nothing  in  the  law  authorizes  any  itinerant  doctor  to  regis- 
ter or  practise  medicine  {ib.,  s.  4). 

The  board  may  refuse  a  certificate  to  any  individual  guilty 
of  grossly  unprofessional  conduct  of  a  character  likely  to  de- 
ceive or  defraud  the  public,  and  may,  after  due  notice  and  hear- 
ing, revoke  such  certificates  for  like  cause.  In  cases  of  refusal 
or  revocation  the  applicant  may  appeal  to  the  governor,  whose 
decision  affirming  or  overruling  the  decision  of  the  board  shall 
be  final  {ib.,  s.  5). 

Systems,  Exceptions. — The  law  does  not  discriminate 
against  any  peculiar  school  or  system  of  medicine,  nor  pro- 
hibit women  from  practising  midwifery,  nor  prohibit  gratui- 
tous services  m  case  of  emergency,  nor  apply  to  commissioned 
surgeons  in  the  United  States  army,  navy,  or  marine  hospital 
service,  nor  to  a  legally  qualified  physician  of  another  State 
called  to  see  a  particular  case  or  family,  but  who  does  not  open 
an  office  or  appoint  a  place  in  the  State  to  meet  patients  or  re- 
ceive calls  {ib.,  s.  6). 

Penalty. — Anj^  person  living  in  this  State  or  coming  into 
this  State  who  shall  practise  medicine  or  attempt  to  practise 
medicine  in  any  of  its  branches,  or  perform  or  attempt  to  per- 
form any  surgical  operation  for  or  upon  any  person  for  reward 
or  compensation  in  violation  of  this  law,  shall  be  punished 
with  a  fine  of  $50,  and  on  each  subsequent  conviction  by  a 
fine  of  $100  and  imprisonment  for  thirty  days,  or  either,  or 
both ;  and  in  no  case  where  any  provision  of  this  law  has  been 
violated  shall  the  violator  be  entitled  to  receive  compensation 
for  services  rendered.  To  open  an  office  for  such  purpose  or 
to  announce  to  the  public  in  any  other  way  a  readiness  to 
11 


162  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

practise  medicine   in  any  county  shall  be   to   engage   in   the 
practice  of  medicine  {ib.,  s.  8). 

Fees. — To  the  county  clerk,  for  all  services  required,  50 
cents  {ib.,  s.  1). 

Louisiana. 

Constitutional  Provision. — The  general  assembly  must 
provide  for  the  interest  of  State  medicine  in  all  its  departments, 
and  for  the  protection  of  the  people  from  unqualified  practi- 
tioners of  medicine  (Const.  1879,  Art.  178). 

Qualification. — No  person  is  allowed  to  practise  medicine 
or  surgery  as  a  means  of  livelihood  in  any  of  its  departnients, 
without  first  making  aflBdavit  before  a  judge,  justice  of  the  peace, 
clerk  of  district  court,  or  notary  public  in  the  parish  wherein  he 
resides,  of  his  having  received  the  degree  of  doctor  of  medicine 
from  a  regularly  incorporated  medical  institution  of  respectable 
standing,  in  America  or  in  Europe,  and  designating  its  name  and 
locality,  and  the  date  of  his  diploma ;  the  degree  is  manifested 
by  the  diploma,  and  the  respectable  standing  of  the  institution 
is  evidenced  by  the  indorsement  or  certificate  of  the  State  board 
of  health,  written  on  the  face  of  the  diploma,  and  signed  by  its 
secretary ;  the  affidavit  must  contain  the  full  name  of  the  per- 
son making  the  same,  the  date  and  place  of  his  birth,  and  the 
names  of  the  places  where  he  may  have  previously  practised 
medicine  or  surgery ;  a  record  of  the  diplomas  certified  must  be 
presented  by  the  State  board  of  health,  and  copies  thereof,  cer- 
tified by  the  secretary,  are  received  in  evidence.  The  State 
board  of  health  is  required  to  certify  the  diploma  of  any  medi- 
cal institution  of  credit  and  respectability  without  regard  to  its 
sj^stem  of  therapeutics  and  whether  the  same  be  regular,  homoe- 
opathic, or  eclectic  (Act  1882,  No.  31,  s.  1). 

The  affidavit  required  by  sec.  1  must  be  recorded  in  the 
office  of  the  clerk  of  the  district  court  of  the  parish ;  the  clerk 
must  certify  the  recordation  by  indorsement  on  the  original 
affidavit,  which  the  affiant  must  transmit  to  the  State  board  of 
health;  a  copy  of  the  original  affidavit,  dul}^  certified  by  the 
clerk  of  the  court,  is  admissible  in  evidence  {ib.,  s.  2). 

Exceptions. — The  provisions  of  the  act  do  not  apply  to 
female  practitioners  of  midwifery  as  such,  nor  to  persons  who 
had  been  practising  medicine  or  surgery  in  the  State  without 


LOUISIANA.  103 

diplomas  for  five  years  prior  to  the  passage  of  the  act,  nor  to 
persons  who  had  been  practising  medicine  or  surgery  from  a 
regularly  incorporated  medical  institution  of  reputable  standing 
in  America  or  in  Europe,  for  ten  years  prior  to  the  passage  of 
the  act,  provided  such  a  practitioner  make  affidavit  before  a 
judge,  justice  of  the  psace,  notary  public,  or  the  clerk  of  the  court 
of  the  parish  wherein  he  resides,  setting  forth  the  full  name  of 
the  affiant,  the  date  and  place  of  his  birth,  the  date  of  his  di- 
ploma, if  he  have  any,  the  name  and  locality  of  the  institution 
by  which  it  was  made,  the  date  and  place  where  ho  began  the 
practice  of  medicine  in  Louisiana,  and  the  names  of  the  places 
where  he  may  have  previously  practised  medicine  or  surgerj 
such  affidavit  must  be  transmitted  or  delivered  to  the  State 
board  of  health,  and  entitles  the  affiant  to  be  placed  on  the  list 
of  registered  physicians  or  surgeons.  The  State  board  of  health 
must  preserve  said  affidavits,  and  a  copy  signed  by  the  secretary 
is  received  in  evidence  by  the  courts.  To  make  a  false  affidavit 
is  perjur}^  {ih.,  s.  3). 

Evidence. — A  copy  of  the  affidavit  recorded  by  the  clerk 
of  the  district  court,  certified  by  him,  is  prima  facie  evidence 
that  the  person  making  the  affidavit  is  a  duly  registered  phj-si- 
cian  or  surgeon,  and  a  certified  copy  of  the  original  affidavit 
filed  with  the  State  board  of  health,  or  a  certificate  emanating 
from  the  said  board,  that  the  name  of  the  person  mentioned  in 
the  certificate  is  on  the  list  of  registered  physicians  and  sur- 
geons, is  conclusive  evidence  {ih.,  s.  4). 

It  is  the  duty  of  the  State  board  of  health  to  publish  annually 
in  the  official  journal  of  the  State,  and  if  there  is  none,  in  one 
of  the  daily  newspapers  published  in  New  Orleans,  a  list  of  the 
registered  physicians  and  surgeons,  and  their  places  of  resi- 
dence, and  such  published  list  is  evidence  in  the  courts  that  the 
person  is  duly  registered.  The  board  is  required  to  strike  from 
said  list  the  names  of  persons  convicted  of  any  infamous  crimes 
by  any  court  of  this  State  or  of  the  United  States,  or  of  any 
State  of  the  United  States,  whether  prior  or  posterior  to  regis- 
tration; and  is  empowered  to  strike  from  the  list  persons  who 
die  after  registration  {ih.,  s.  5). 

Civil  Penalty. — A  practitioner  of  medicine  or  surgery  fail- 
ing to  comply  with  this  act  shall  not  be  exempt  from  military 
or  jury  duty,  nor  be  permitted  to  collect  fees  for  services  rendered, 


164  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

nor  be  allowed  to  testify  as  a  medical  or  surgical  expert  in  legal 
or  State  medicine,  in  any  court,  nor  to  execute  any  certificate  as 
surgeon  or  physician,  nor  to  hold  any  medical  office,  nor  to  be 
recognized  by  the  State,  or  any  parish,  or  municipal  corporation, 
as  a  phj^sician  or  surgeon,  nor  entitled  to  enjoy  any  of  the 
privileges,  rights,  or  exemptions  granted  to  physicians  and  sur- 
geons by  the  laws  of  this  State;  and  shall  forfeit  SlOO  for 
each  violation,  to  be  recovered  in  a  civil  action  in  the  name  of 
and  for  the  benefit  of  the  Charity  Hospital  at  New  Orleans,  and 
in  addition  shall  be  subject  to  criminal  prosecution  (ib.,  s.  6). 

Exceptions. — The  act  is  not  applicable  to  practitioners  of 
medicine  or  surgery  residing  and  practising  in  other  States, 
who  may  be  summoned  in  special  instances  to  attend  patients 
in  the  State  of  Louisiana  by  any  registered  physician  {ib.,  s.  7). 

Penalty. — Whoever  shall  practise  or  offer  to  practise  med- 
icine or  surgery,  for  pay,  without  complying  with  the  foregoing 
act,  is  guilty  of  a  misdemeanor,  punishable  hj  a  fine  of  not  less 
than  $50  or  imprisonment  for  not  more  than  three  months,  or 
both,  at  the  discretion  of  the  court  (Act  1886,  No.  55,  s.  1). 

No  criminal  prosecution  shall  bar  the  imposition  of  a  fine 
by  civil  process,  nor  shall  the  imposition  of  such  fine  bar  crim- 
inal prosecution  {ib.,  s.  2). 

Exceptions. — This  act  is  not  applicable  to  practitioners  of 
medicine  or  surgery  residing  and  practising  in  other  States, 
who  may  be  summoned  in  special  instances  to  attend  patients 
in  the  State  by  any  registered  phj^sician  {ib.,  s.  3). 

Fees. — To  board  of  health,  for  every  diploma  certified,  50 
cents  {ib.,  s.  1). 

To  officer  before  whom  affidavit  is  made,  50  cents  {ib.,  s. 
2,  3). 

Recording  same,  81  {ib.,  s.  2). 

To  clerk  of  court,  for  copy  of  original  affidavit,  50  cents 
{ib.,  s.  2). 

To  State  board  of  health,  for  copy  of  original  affidavit,  50 
cents  {ib.,  s.  3). 

Maine. 

Qualification,  Penalty. — No  person  who  has  not  received 
a  medical  degree  at  a  public  medical  institution  in  the  United 
States,  or  a  license  from  the  Maine  Medical  Association,  shall 


MAINE — MARYLAND.  165 

recover  compensation  for  medical  or  surgical  services,  unless 
previous  to  such  service  he  had  obtained  a  certificate  of  good 
moral  character  from  the  municipal  officers  of  the  town  where 
he  then  resided  (Rev.  Stats.,  1883,  c.  13,  s.  9). 

Maryland. 

Qualification. — By  the  Act  of  1892,  c.  296,  s.  1,  39,  it  is 
provided  that  every  person  not  now  practising  medicine  and 
surgery,  who  shall  hereafter  begin  to  practise  medicine  and 
surgery  in  any  of  its  departments,  shall  possess  the  qualifications 
required  by  the  act. 

There  are  two  boards  of  examiners,  representing  the  medical 
and  chirurgical  faculty  of  the  State  and  the  State  Homa?opathic 
Medical  Societ}"  respectively ;  each  consists  of  seven  members, 
appointed  respectively  by  those  societies,  physicians  actually  en- 
gaged in  the  practice  of  medicine,  and  of  recognized  abilit}'  and 
honor;  but  no  physician  having  a  pecuniary  interest  in  the 
trade  of  pharmacy  can  be  appointed  {ib.,  s.  2). 

Suitable  provisions  must  be  made  by  each  examining  board 
to  prepare  a  schedule  of  written  examination  upon  anatomy, 
physiology,  chemistry,  surgery,  practice  of  medicine,  materia 
medica  and  therapeutics,  obstetrics,  gyngecology,  pathologj'', 
medical  jurisprudence  and  hygiene ;  the  same  standard  of  ex- 
cellence is  required  from  all  candidates;  in  therapeutics  and 
practice,  the  questions  must  be  in  harmony  with  the  tenets  of 
the  school  selected  by  the  candidate ;  and  the  standard  of  ac- 
quirements therein  is  established  by  each  board  itself.  The 
examination  must  be  fundamental  in  character  and  such  as  can 
be  answered  in  common  by  all  schools  of  practice  (ib.,  s.  1,  42). 

Application  for  license  is  made  in  writing  to  the  president 
of  either  board  of  medical  examiners  which  the  applicant  may 
elect,  with  satisfactory  proof  that  the  applicant  is  more  than 
twenty-one  years  of  age,  is  of  good  moral  character,  has  ob- 
tained a  competent  common-school  education,  and  has  either 
received  a  diploma  conferring  the  degree  of  Doctor  of  Medicine 
from  some  legally  incorporated  medical  college  in  the  United 
States,  or  a  diploma  or  license  conferring  the  full  right  to  prac- 
tise all  the  branches  of  medicine  and  surger}'  in  some  foreign 
country,  and  has  also  both  studied  medicine  three  years  and 


166  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

attended  three  courses  of  lectures  in  different  years  in  some 
legally  incorporated  medical  college  or  colleges  prior  to  the 
granting  of  the  diploma  or  foreign  license ;  two  courses  of  med- 
ical lectures  both  begun  or  completed  within  the  same  calendar 
3"ear  do  not  satisfy  the  requirement;  this  condition  is  not  ap- 
plicable to  students  who  shall  be  in  their  second  year  in  a  med- 
ical college,  nor  to  physicians  practising  at  the  time  of  the 
passage  of  the  act.  Such  proof  is  made,  if  required,  upon  aflB- 
davit,  upon  making  the  application  and  proof  and  paj^ment  of 
the  fee.  The  president  of  the  board,  if  satisfied,  must  direct 
the  secretary  to  issue  an  order  for  examination,  and  when  the 
applicant  shall  have  passed  an  examination  as  to  proficiency 
satisfactory  to  the  board,  the  president  must  grant  a  license  to 
practise  medicine  and  surgery  {ib.,  s.  1,  43). 

All  of  the  examinations  are  conducted  so  that  the  name, 
school  of  graduation,  and  preparatory  training  of  the  applicant 
shall  not  be  made  known  to  the  board  till  his  examination 
papers  have  been  graded.  '  An  applicant  receiving  a  majoritj^ 
of  the  votes  of  the  board  is  considered  to  have  passed  a  satis- 
factory examination  and  is  entitled  to  a  license  {ib.,  s.  1,  44). 

The  board  must  refuse  a  license  to  an  applicant  radically 
deficient  in  any  essential  branch.  In  case  of  a  failure,  the  can- 
didate must  have  the  privilege,  after  the  expiration  of  one  year 
from  his  rejection,  of  another  examination  by  the  board  to 
which  his  application  was  first  made  {ib.,  s,  1,  46). 

A  license,  or  a  certified  copy,  must  be  filed  with  the  clerk 
6t  the  circuit  court  of  the  county  or  city  in  which  the  licensee 
may  practise ;  the  number  of  the  book  and  page  containing  the 
recorded  copy  must  be  noted  in  the  body  of  license. 

Evidence. — The  records  have  the  same  weight  as  evidence 
that  is  given  to  the  record  of  conveyances  of  land  {ib.,  s.  1,  48). 

Exceptions. — The  act  does  not  apply  to  commissioned 
surgeons  of  the  United  States  army,  navy,  or  marine  hospital 
service,  to  physicians  or  surgeons  in  actual  consultation  from 
other  States,  nor  to  persons  temporarily  practising  under  the 
supervision  of  an  actual  medical  preceptor,  nor  to  a  midwife  or 
person  who  may  render  gratuitous  services  in  case  of  emergency 
{ib.,  s.  1,  49,  51). 

Penalty. — Practising,  or  attempting  to  practise,  without 
a  license  is  a  misdemeanor  punishable  with  a  fine  of  from  $50 


MARYLAND — MICHIGAN.  1(37 

to  $200  for  each  offence,  with  confinement  in  jail,  in  default  of 
payment,  till  fine  and  costs  are  paid ;  a  person  so  practising  is 
debarred  from  recovering  compensation  (^6,,  s.  1,  50). 

Fees. — To  secretary  of  board,  before  examination,  $10  {ib.y 
s.  1,  45). 

To  clerk  of  court,  for  registration,  $1   {ib.,  s.  1,  48). 

Massachusetts. 
In  Massachusetts  there  is  no  statute  upon  this  subject. 

Michigan. 

Qualification. — It  is  unlawful  to  practise  medicine  or 
surgery  or  any  branch  except  dentistry,  without  the  prescribed 
qualifications  and  registration  in  the  office  of  the  county  clerk 
(Laws  1883,  c.  167,  s.  1). 

A  person  who  was  practising  when  the  law  took  effect,  and 
had  been  practising  continuously  for  at  least  five  years  prior 
thereto  in  the  State,  is  deemed  qualified  to  practise  medicine 
after  registration  (ib.,  s.  2,  as  amended  1887,  c.  268). 

A  graduate  of  a  legally  authorized  medical  college  in  the 
State,  or  any  of  the  United  States,  or  any  other  countr}^,  is 
deemed  qualified  to  practise  medicine  and  surgery  in  all  de- 
partments after  registration.  A  student  or  undergraduate  is 
not  prohibited  from  practising  with  and  under  the  immediate 
supervision  of  a  person  legally  qualified  to  practise  medicine 
and  surgery  (ib.). 

A  person  qualified  registers  by  filing  with  the  county  clerk 
of  the  count}'"  where  he  practises,  or  intends  to  practise,  a  sworn 
statement  setting  forth,  if  actually  engaged  in  practice,  the 
length  of  time  he  has  been  engaged  in  such  continuous  practice ; 
if  a  graduate  of  a  medical  college,  the  name  and  location  of  the 
same,  when  he  graduated  and  how  long  he  attended  the  same, 
and  the  school  of  medicine  to  which  he  belongs;  if  a  student  or 
undergraduate,  how  long  he  has  been  engaged  in  the  study  of 
medicine  and  where,  and  if  he  has  attended  a  medical  college, 
its  name  and  location  and  the  length  of  his  attendance,  and 
when,  and  the  name  and  residence  of  the  physician  inuler 
whose  instruction  he  is  practising,  or  intends  to  practise.  The 
statement  is  to  be  recorded  by  the  clerk  (ib.). 


168  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

Penalty. — No  person  practising  medicine,  surgery,  or  mid- 
wifery can  collect  pay  for  professional  services  unless  at  the 
time  of  rendering  such  services  he  was  duly  qualified  and  reg- 
istered {ih.,  s.  4). 

Advertising,  or  holding  out  to  the  public,  as  authorized  to 
practise  medicine  or  surger}-,  when  not  authorized,  is  a  misde- 
meanor punishable  with  a  fine  of  from  $5  to  $50  for  each  offence 
{ih.,  s.  7). 

Fees. — To  county  clerk,  for  recording  statement,  50  cents 
{ih.,  s.  2). 

Minnesota. 

Board  of  Examiners. — The  governor  appoints  a  board  of 
medical  examiners  of  nine  members,  no  one  of  whom  can  be 
a  member  of  a  college  or  university  having  a  medical  depart- 
ment, and  two  of  whom  must  be  homoeopathic  physicians  (Act 
1887,  c.  9,  s.  1). 

Qualification. — Persons  commencing  the  practice  of  med- 
icine and  surgery  in  any  of  its  branches  must  apply  to  the  board 
for  a  license,  and  at  the  time  and  place  designated  by  the  board, 
or  at  a  regular  meeting,  submit  to  an  examination  in  anatomy, 
physiology,  chemistry,  histology,  materia  medica,  therapeutics, 
preventive  medicines,  practice  of  medicine,  surgery,  obstetrics, 
diseases  of  women  and  children,  of  the  nervous  system,  of  the 
eye  and  ear,  medical  jurisprudence,  and  such  other  branches  as 
the  board  deems  advisable,  and  present  evidence  of  having  at- 
tended three  courses  of  lectures  of  at  least  six  months  each ;  the 
examination  must  be  scientific  and  practical,  but  of  sufficient 
severity  to  test  the  candidate's  fitness  to  practise  medicine  and 
surgery.  When  desired,  the  examination  may  be  conducted  in 
the  presence  of  the  dean  of  any  medical  school  or  the  president 
of  any  medical  society  of  this  State.  After  examination,  the 
board  must  grant,  with  the  consent  of  at  least  seven  members, 
a  license  to  practise  medicine  and  surgery,  which  may  be  refused 
or  revoked  for  unprofessional,  dishonorable,  or  immoral  con- 
duct; and  in  case  of  refusal  or  revocation,  the  applicant  may 
appeal  to  the  governor  {ih.,  s.  3). 

The  license  must  be  recorded  with  the  clerk  of  the  district 
court  in  the  county  in  Avhich  the  licensee  resides ;  if  he  moves 
into  another  county  he  must  procure  a  certified  copy  of  his 


MINNESOTA — MISSISSIPPI.  109 

license  from  the  said  clerk  and  file  it  with  the  clerk  of  the  dis- 
trict court  in  the  latter  county  {ib.,  s.  4). 

Penalty. — To  practise  without  a  license  is  a  misdemeanor, 
punishable  by  a  fine  of  from  $50  to  $100,  or  imprisonment  in 
county  jail  from  ten  to  ninety  days,  or  both.  Appending  "  M.  D. " 
or  "  M.B."  to  name,  or  prescribing,  directing,  or  recommending 
for  use  any  drug  or  medicine  or  other  agency  for  the  treatment, 
care,  or  relief  of  any  wound,  fracture,  or  bodily  injury,  infirm- 
ity, or  disease,  is  regarded  as  practising  medicine. 

Exceptions. — The  act  is  not  applicable  to  dentists  {ib.,  s. 
6),  nor  to  commissioned  surgeons  of  the  United  States  army  or 
navy,  nor  to  physicians  or  surgeons  in  actual  consultation  from 
other  States  or  Territories,  nor  to  actual  medical  students  prac- 
tising medicine  under  the  direct  supervision  of  a  preceptor 
{ib.,  s.  5). 

All  persons  licensed  under  the  Act  of  1883,  c.  125,  are  re- 
garded as  licensed  under  this  act  {ib.,  s.  7). 

Fees. — To  treasurer  of  board,  for  examination,  $10. 

Mississippi. 

Qualification. — A  practitioner  of  medicine  must  obtain 
a  license  from  the  State  board  of  health  (Code  1892,  s.  3,243). 

Application  is  made  in  writing;  and  an  examination  is 
made  in  anatomy,  chemistry,  obstetrics,  materia  medica,  phys- 
iology, pathology,  surgery,  and  hygiene,  and  if  the  applicant 
is  found  b}?^  the  board  to  possess  sufficient  learning  in  those 
branches,  and  of  good  moral  character,  the  board  issues  a  license 
to  practise  medicine,  signed  by  each  member  who  approves 
{ib.,  s.  3,244). 

The  application  must  state  the  applicant's  full  name,  place 
of  residence,  and  post-office  address,  nativity  and  age,  time 
spent  in  medical  studies,  name  and  post-office  address  of  the 
preceptor  under  whom  his  medical  studies  were  pursued,  the 
courses  of  medical  lectures  attended,  the  name  of  medical 
schools  attended ;  if  a  graduate  of  n  medical  college,  the  name 
thereof;  the  time  spent  in  a  hospital,  the  time  spent  in  the 
practice  of  medicine,  if  an 5%  the  school  or  s^^stem  of  practice 
chosen,  and  references  as  to  his  personal  character  {ib.,  s. 
3,245). 


170  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

Examinations  are  to  be  conducted  at  the  capital  on  the  first 
Tuesday  in  April  and  October  annually,  and  continue  until  all 
applicants  are  examined  and  the  examinations  are  approved  or 
disapproved;  they  are  upon  written  questions  and  answers,  and 
no  distinction  can  be  made  between  applicants  because  of  differ- 
ent systems  or  schools  of  practice. 

The  license  must  be  filed  in  the  office  of  the  clerk  of  the 
circuit  court  of  the  county  in  which  the  licensee  resides,  within 
sixty  days  from  the  date  of  its  issue ;  otherwise  it  becomes  void. 
The  clerk  must  record  the  same  with  his  certificate  of  filing  and 
deliver  the  original  to  the  licensee.  When  the  licensee  changes 
the  county  of  his  residence  and  usual  practice,  he  must  file  the 
original  or  a  certified  copy  of  license,  or  record,  in  the  office  of 
said  clerk  in  the  county  into  which  he  shall  move  and  practise 
within  sixty  days  of  the  time  of  his  removal,  to  be  there  re- 
corded (^&.,  s.  3,249). 

The  board  may  issue  a  duplicate  in  place  of  a  lost  license 
{ib.,  s.  3,250). 

The  secretary  of  the  board  may  issue  a  temporary  license 
which  shall  be  valid  until  the  next  succeeding  meeting  of 
board,  such  license  to  show  its  date  of  issue,  otherwise  to  be 
void ;  it  must  be  recorded  as  a  permanent  license  is  required 
to  be ;  only  one  temporary  license  shall  ever  be  issued  to  the 
same  person,  and  it  shall  always  be  made  to  an  individual  and 
not  to  a  partnership  (ib.,  s.  3,251). 

Physicians  practising  by  virtue  of  a  license  under  prior  laws 
are  not  required  to  obtain  a  license  under  this  law  and  may 
continue  in  practice  under  their  licenses,  but  they  must  comply 
with  the  requirements  of  this  law  with  reference  to  recording 
{lb.,  s.  3,252). 

Penalty. — To  practise  without  an  examination  and  a  license 
is  punishable  with  a  fine  of  from  $20  to  $200,  or  to  imprison- 
ment in  the  county  jail  not  to  exceed  thirty  days  {ib.,  s.  1,258). 

Exceptions. — Females  engaged  in  the  practice  of  mid- 
wifery need  no  license  for  that  emploj'ment  (ib.,  s.  3,253). 

Non-Residents. — Licensed  physicians  residing  without  the 
State,  and  whose  practice  extends  into  it,  may  obtain  a  license 
without  examination  by  presenting  an  application  in  the  form 
prescribed ;  whereupon  the  secretary  of  the  board  must  issue 
a  license  in  the  name  of  the  board  and  the  license  must  be  re- 


MISSISSIPPI— MISSOURI.  171 

corded  as  hereinbefore  provided,  in  each  county  in  which  the 
licensee  shall  practise  {ih.,  s.  3,254). 

Fees. — To  board,  before  examination,  $10. 

To  secretary,  before  examination,  25  cents  {ih.^  s.  3,247). 

To  secretary,  for  temporary  license,  25  cents  (^7).,  s.  3,251). 

To  secretary,  for  license  to  non-resident,  25  cents  {ib.,  s. 
3,245). 

To  the  clerk  of  the  court,  for  recording,  his  legal  fees  {ih., 
s.  3,249). 

Missouri. 

Qualification. — Every  person  practising  medicine  and 
surgery,  in  any  of  their  departments,  must  possess  the  quali- 
fications required.  If  a  graduate  of  medicine,  he  must  present 
his  diploma  to  the  State  board  of  health  for  verification  as  to 
its  genuineness.  If  the  diploma  is  found  to  be  genuine,  and 
the  person  named  therein  to  be  the  person  claiming  and  pre- 
senting the  same,  the  board  must  issue  a  certificate  which 
is  conclusive  of  the  right  to  practise.  If  not  a  graduate,  he 
must  submit  to  such  examination  as  the  board  shall  require, 
and  if  the  examination  is  satisfactory  to  the  examiners  tlie 
board  must  issue  its  certificate  in  accordance  with  the  facts, 
and  the  holder  shall  be  entitled  to  all  the  rights  and  privileges 
herein  mentioned  (Rev.  Stats.,  1889,  s.  6,871). 

The  board  must  issue  certificates  to  all  who  furnish  satis- 
factory proof  of  having  received  a  diploma  or  license  from  a 
legally  chartered  medical  institution  in  good  standing,  of  what- 
ever school  or  system  of  medicine,  and  shall  not  make  any 
discrimination  against  the  holders  of  genuine  licenses  or  di- 
plomas under  any  school  or  system  of  medicine  {ih.,  s.  ri,872). 

The  verification  of  a  diploma  consists  in  the  aflSdavit  of  the 
holder  and  applicant  that  he  is  the  lawful  possessor  of  the  same, 
and  the  person  therein  named;  the  affidavit  may  be  taken 
before  any  person  authorized  to  administer  oaths,  and  shall  be 
attested  under  the  hand  and  official  seal  of  such  officer,  if  he 
have  a  seal.  Graduates  may  present  their  diplomas  and  affi- 
davits by  letter  or  proxj^  {ih.,  s.  6,873). 

All  examinations  are  made  directlj^  by  the  board,  and  the 
certificates  authorize  the  possessor  to  practise  medicine  and 
surgery  in  the  State  {ib.,  s.  6,874). 


173  SYNOPSIS   OF   LAWS — POSTE   AXD   BOSTON. 

The  certificate  must  be  recorded  in  the  office  of  the  county 
clerk  of  the  county  in  which  the  holder  resides  and  the  record 
must  be  indorsed  thereon ;  a  person  moving  to  another  county 
to  practise  must  procure  an  indorsement  to  that  ejffect  on  the 
certificate  from  the  said  clerk,  and  have  the  certificate  recorded 
in  the  office  of  the  clerk  of  the  county  to  which  he  removes 
{lb.,  s.  6,875). 

Examinations  may  be  made  wholly  or  partly  in  writing  and 
must  be  of  an  elementary  and  practical  character,  but  suffi- 
ciently strict  to  test  the  qualifications  of  the  candidate  as  a 
practitioner  {lb.,  s.  G,877). 

The  board  may  refuse  a  certificate  to  an  individual  guilty 
of  unprofessional  or  dishonorable  conduct,  and  may  revoke  a 
certificate  for  like  causes  after  giving  the  accused  an  opportu- 
nity to  be  heard  {lb.,  s.  6,878). 

Definition,  Exception. — A  person  is  regarded  as  practis- 
ing medicine  who  professes  publicly  to  be  a  physician  and  to 
prescribe  for  the  sick,  or  who  appends  to  his  name  "M.D.," 
but  students  are  not  prohibited  from  prescribing  under  the 
supervision  of  a  preceptor,  and  gratuitous  services  may  be  ren- 
dered in  case  of  emergencj",  and  the  act  does  not  apply  to 
commissioned  surgeons  of  the  United  States  army  or  navy  or 
marine  hospital  service  {ib,  s.  6,879). 

Itinerant  Venders. — Every  itinerant  vender  of  any  drug, 
nostrum,  ointment,  or  appliance  intended  for  the  treatment  of 
disease  or  injury,  or  who  publicly  professes  to  cure  or  treat 
disease,  injury,  or  deformity  by  any  drug,  nostrum,  manipula- 
tion, or  other  expedient,  must  pay  a  license  fee  of  $100  per 
month;  the  violation  of  this  section  is  a  misdemeanor,  punish- 
able with  a  fine  not  exceeding  8500  or  imprisonment  in  the 
county  jail  not  to  exceed  six  months,  or  both  {ib.,  s.  6,880). 

Penalty. — The  violation  of  the  provisions  of  this  act  is  a 
misdemeanor  punishable  with  a  fine  of  from  $50  to  $500,  or  im- 
prisonment in  the  county  jail  for  from  thirtj'  to  three  hundred 
and  sixty-five  daj^s,  or  both,  for  each  offence ;  filing  or  attempt- 
ing to  file  the  certificate  of  another,  or  a  forged  affidavit  or 
identification,  is  a  felony  punishable  as  forgery  in  the  second 
degree,  but  the  provisions  of  this  article  do  not  apply  to  persons 
who  had  been  practising  five  years  in  the  State  prior  to  1883 
(ib.,  s.  6,881). 


MISSOURI — MONTANA.  173 

Fees. — To  the  secretary  of  the  board,  for  examining  a 
genuine  diploma,  SI. 

If  fraudulent  or  not  owned  by  the  possessor,  820  (ib.,  s. 
6,873). 

To  the  clerk,  for  recording,  the  usual  fees  {ib.,  s.  6,875). 

Montana. 

Board  of  Examiners.— The  governor,  with  the  advice 
and  consent  of  the  council,  appoints  seven  learned,  skilled,  and 
capable  physicians  who  have  been  residents  for  not  less  than 
two  3"ears,  no  more  than  two  from  the  same  county,  to  con- 
stitute the  board  of  examiners  (Act  of  February  28tli,  1889, 

s.  1). 

Meetings  of  the  board  for  examination  are  required  to  be 
held  at  the  capital  and  such  other  central  points  as  the  board 
may  select,  on  the  first  Tuesday  of  April  and  October  in  each 
year,  and  at  other  times  as  the  board  may  determine.  The 
board  must  keep  a  record  of  all  applicants  for  a  certificate,  with 
their  age,  time  spent  in  the  study  of  medicine,  name,  and  the 
location  of  all  institutions  granting  to  applicants  degrees  or 
certificates  of  lectures  in  medicine  or  surgery,  and  whether  the 
applicant  was  rejected  or  received  a  certificate,  and  the  register 
is  prima  facie  evidence  of  matters  therein  recorded  {ib.,  s.  2). 

Qualification. — Every  person  wishing  to  practise  med- 
icine or  surger}'^  in  an}'  of  their  departments  shall  do  so  only 
upon  complj'ing  with  the  requisites  of  this  act.  If  a  graduate 
in  medicine,  he  must  present  his  diploma  to  the  board  for  veri- 
fication as  to  its  genuineness.  If  it  be  found  genuine  and 
issued  by  a  medical  school  legally  organized  and  in  good 
standing,  whose  teachers  are  graduates  of  a  legally  organized 
school,  which  fact  the  board  determines,  and  if  the  person 
presenting  and  claiming  the  diploma  be  the  person  to  whom  it 
was  originally  granted,  the  board  must  issue  its  certificate, 
which  shall  be  conclusive  of  the  holder's  right  to  practise. 
Any  person  coming  to  the  State  may  present  his  diploma  to  any 
member  of  the  board,  who  maj'"  issue  a  certificate  good  till  the 
board's  next  regular  meeting.  If  not  a  graduate,  the  person 
must  present  himself  to  the  board  for  such  examination  as  may 
be  required,  unless  he  shall  have  been  in  continuous  practice 


174  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

in  the  State  for  not  less  than  ten  years,  of  which  fact  he  must 
present  satisfactory  evidence  in  the  form  of  affidavits  to  the 
board  {ib.,  s.  3). 

All  persons  entitled  to  practise  under  the  ten-year  provision 
and  all  persons  commencing  the  practice  of  medicine  and  sur- 
gery in  any  of  its  branches  shall  apply  to  the  board  for  a  certifi- 
cate, and  at  the  time  and  place  designated  by  the  board,  or  at  the 
regular  meeting,  be  examined  in  anatomy,  physiology,  chemis- 
try, histology,  materia  medica,  therapeutics,  preventive  medi- 
cines, practice  of  medicine,  surger}^,  obstetrics,  diseases  of 
women  and  children,  diseases  of  the  nervous  system,  diseases 
of  the  eye  and  ear,  medical  jurisprudence,  and  such  other 
branches  as  the  board  may  deem  advisable,  and  present  evidence 
of  having  practised  the  required  term  of  ten  years,  or  of  having 
attended  three  courses  of  lectures  of  at  least  four  months  each ; 
the  examination  must  be  both  scientific  and  practical,  and  of 
sufficient  thoroughness  and  severity  to  test  the  candidate's  fit- 
ness to  practise  medicine  and  surgery.  The  examination  may 
be  held  in  the  presence  of  the  dean  of  any  medical  school  or  of 
the  president  of  any  medical  society  of  the  State.  After  the 
examination,  the  board  must  grant  to  a  candidate  who  is  found 
qualified,  a  certificate  to  practise  medicine  and  surgery.  The 
board  may  refuse  or  revoke  a  certificate  for  unprofessional, 
dishonorable,  or  immoral  conduct,  or  maj"  refuse  a  certificate  to 
any  one  who  may  publiclj^  profess  to  cure  or  treat  diseases,  in- 
juries, or  deformities  in  such  manner  as  to  deceive  the  public. 
In  cases  of  refusal  or  revocation,  the  aggrieved  ap^Dlicant  may 
appeal  to  the  district  court  of  the  county  of  his  application 
{ih.,  s.  4). 

Certificates  must  be  recorded  within  sixty  days  after  their 
date  in  the  office  of  the  county  recorder  in  the  county  where  the 
holder  resides ;  or  in  case  of  removal  certificates  must  be  re- 
corded in  the  county  to  which  the  holder  removes.  The  county 
recorder  must  indorse  on  the  certificate  the  date  of  its  record 
{ih.,  s.  5). 

Exceptions. — The  act  does  not  apply  to  midwives  of  skill 
and  experience  attending  cases  of  confinement,  nor  to  com- 
missioned surgeons  of  the  United  States  army  or  navy  in  the 
discharge  of  their  official  duties,  nor  to  physicians  or  surgeons 
in  actual  consultation  from  other  States  and  Territories,  nor  to 


MONTANA — NEBRASKA.  175 

students  practising  medicine  under  the  direct  supervision  of  a 
preceptor,  nor  to  gratuitous  services  in  cases  of  emergency  {ib., 
s.  6). 

Penalty. — Violation  of  the  act  is  a  misdemeanor,  punish- 
able with  a  fine  of  from  $100  to  $500,  or  imprisonment  in  the 
county  jail  from  thirty  to  ninety  days,  or  both. 

Definition. — Any  person  is  regarded  as  practising  within 
the  meaning  of  the  act  who  appends  "M.D."  or  ''M.B."  to  his 
name,  for  a  fee  prescribes  medicine,  operates  in  surgery,  attends 
in  obstetrics,  or  recommends  for  the  use  of  any  sick  person  the 
use  of  any  drug  or  medicine  or  other  agency  of  treatment,  cure, 
or  relief  of  any  wound,  fracture,  or  bodily  injury  or  disease,  as 
a  physician  or  surgeon  (ib.,  s.  7). 

Be-examination. — Any  one  failing  to  pass  the  examina- 
tion is  entitled  to  a  second  examination  within  six  months 
without  fee  {ib.,  s.  8). 

Fees. — To  the  treasurer  of  the  board,  for  examination,  $15 
(i&.,  s.  4). 

To  the  secretary  of  the  board,  for  examination,  in  advance, 
$15  (ib.,  s.  8). 

To  the  county  recorder,  for  recording,  the  usual  fee  (ib., 
s.  5). 

To  the  count}^  attorney,  for  prosecuting  a  violation,  to  bi- 
charged  as  costs,  $5  [ib.,  s.  7). 

Nebraska. 

Qualification. — It  is  unlawful  for  any  person  to  practise 
medicine,  surgery,  or  obstetrics,  or  any  of  their  branches,  with- 
out having  obtained  and  registered  a  certificate.  No  person 
is  entitled  to  a  certificate  unless  he  be  a  graduate  of  a  legally 
chartered  medical  school  or  college  in  good  standing.  The 
qualifications  are  determined  by  the  State  board  of  health.  The 
act  does  not  prevent  physicians  residing  in  other  States  from 
visiting  patients  in  consultation  with  resident  physicians  who 
have  complied  (Act  of  1891,  c.  35,  s.  7). 

A  medical  school  is  defined  as  a  medical  school  or  college 
which  requires  a  previous  examination  for  admission  to  its 
courses  of  study,  and  which  requires  for  granting  the  degree  of 
"M.D."  attendance  on  at  least  three  courses  of  lectures  of  six 


176  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

luouths  each,  no  two  of  said  courses  to  be  held  within  one 
year,  and  having  a  full  faculty  of  professors  in  anatomy,  phys- 
iology, chemistry,  toxicology,  pathology,  hygiene,  materia 
medica,  therapeutics,  obstetrics,  gynaecology,  p^^^^^c^pZe  (sic) 
and  practice  of  medicine  and  surgery,  and  clinical  instruction 
in  the  last  two  named.  But  the  three-year  clause  does  not 
apply  to  degrees  granted  prior  to  Julj^  1891  {ib.,  s.  8). 

A  person  intending  to  practise  medicine,  surgery,  or  obstet- 
rics must  present  his  diploma  to  the  said  board,  with  his  affi- 
davit that  he  is  the  lawful  possessor  of  the  same  and  has  at- 
tended the  full  course  of  study  required  for  the  degree  of 
"M.D.,"  and  that  he  is  the  person  therein  named.  Such  affi- 
davit may  be  taken  before  any  person  authorized  to  administer 
oaths,  and  it  shall  be  attested  under  the  hand  and  official  seal 
of  the  official,  if  he  have  a  seal.  False  swearing  is  perjury 
{ib.,  s.  9). 

If  investigation  of  the  diploma  and  affidavit  proves  the 
applicant  entitled  to  practise,  the  board  issues  its  certificate, 
which  must  be  filed  in  the  office  of  the  county  clerk  of  the 
county  where  he  resides,  or  intends  to  practise  {ib.,  s.  10). 

The  act  gave  physicians  entitled  to  practise  at  the  time  of 
its  enactment  six  months  in  which  to  comply  with  its  provi- 
sions with  reference  to  them  {ib.,  s.  11). 

The  secretaries  of  the  board  may  issue  certificates,  without 
a  vote  of  the  board,  when  the  proof  upon  which  certificates  are 
granted  may  have  been  on  file  in  its  office  for  ten  days  without 
a  vote  of  the  board,  when  no  protest  has  been  filed,  and  if,  in 
their  opinion,  the  proof  complies  with  the  act  {ib.,  s.  12). 

When  the  holder  of  a  certificate  removes  to  another  county, 
he  must  file  and  record  it  in  the  office  of  the  county  clerk  in  the 
county  to  which  he  removes  {ib.,  s.  13). 

The  board  may  refuse  certificates  to  persons  guilty  of  un- 
professional or  dishonorable  conduct,  and  may  revoke  for  like 
causes  provided  they  give  the  person  an  opportunity  to  be  heard 
{ib.,  s.  14). 

Penalty. — No  person  is  entitled  to  receive  any  sum  of 
money  for  medical,  surgical,  or  obstetrical  service  unless  he  shall 
have  complied  with  the  act  {ib.,  s.  15). 

Violation  of  the  act  is  a  misdemeanor,  punishable  with  a 
fine  of  from  $50  to  $300  and  costs  of  prosecution,  and  a  person 


NEBRASKA — NEVADA,  177 

convicted  shall  stand  committed  till  the  fine  and  costs  are  paid 
(lb.,  s.  16). 

Definition,  Exceptions. — To  operate  on,  profess  to  heal, 
prescribe  for,  or  otherwise  treat  any  physical  or  mental  ailment 
of  another,  is  to  practise  medicine  under  this  act.  But  it  does 
not  prohibit  gratuitous  services  in  cases  of  emergency,  nor 
apply  to  commissioned  surgeons  in  the  United  States  army  or 
navy,  nor  to  nurses  in  their  legal  occupation,  nor  to  the  admin- 
istration of  ordinary  household  remedies  {ib.,  s.  17). 

Itinerant  Vender. — To  be  an  itinerant  vender  of  any  drug, 
nostrum,  ointment,  or  appliance  for  the  treatment  of  disease  or 
injury,  or  for  such  an  one  to  publicly  profess  to  cure  or  to  treat 
disease  or  injury  or  deformity  by  any  drug,  nostrum,  manip- 
ulation, or  other  expedient,  is  a  misdemeanor  punishable  with 
a  fine  of  from  $50  to  $100,  or  imprisonment  in  the  county  jail 
from  thirty  days  to  three  months,  or  both,  for  each  ollPence 
(ib.,  s.  18). 

Fees. — To  the  secretaries  of  the  board  of  health,  for  certifi- 
cate at  time  of  application,  $5. 

To  the  secretaries  of  the  board  of  health,  for  taking  testi- 
mony, same  fees  as  a  notary  public  is  allowed  for  same  ser- 
vice (ib.,  s.  19). 

To  county  clerk,  for  recording,  usual  register's  fees  for  re- 
cording (lb.,  s.  10). 

Nevada. 

Qualification. — No  person  can  lawfully  practise  medicine 
or  surgery  who  has  not  received  a  medical  education  and  a 
diploma  from  some  regularly  chartered  medical  school  having 
a  bona  fide  existence  when  the  diploma  was  granted  (Act  of 
1875,  c.  4r3,  s.  1). 

A  copy  of  the  diploma  must  be  filed  for  record  Avith  the 
county  recorder  of  the  county  in  which  the  person  practises, 
and  at  the  same  time  the  original,  or  a  certificate  from  the 
dean  of  the  medical  school  of  which  he  is  a  graduate,  certif  j4ng 
to  his  graduation,  nmst  be  exhibited  {ib.,  s.  2). 

The  person  filing  a  copy  of  a  diploma  or  a  certificate  of 

graduation  must  be  identified  as  the  person  named  therein,  by 

the  affidavit  of  two  citizens  of  the  count}',  or  his  fiffidavit  taken 

before  a  notary  public  or  commissioner  of  deeds  for  this  State, 

12 


178  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

which  affidavit  must  be  filed  in  the  office  of  the  county  recorder 
(^■^).,  s.  3). 

Penalty. — Practising  without  complying  with  this  act  is  a 
misdemeanor  punishable  with  a  fine  of  from  $50  to  $500,  or 
imprisonment  in  the  county  jail  from  thirty  days  to  six  months, 
or  both,  for  each  offence.  Filing  a  diploma  or  a  certificate  of 
another  or  a  forged  affidavit  of  identification  is  a  felony  (i6., 
S.4). 

Exceptions. — The  act  does  not  apply  to  a  person  who  in  an 
emergency  may  prescribe  or  give  advice  in  medicine  or  surgery 
in  a  township  where  no  physician  resides,  or  when  no  physi- 
cian or  surgeon  resides  within  convenient  distance,  nor  to  those 
who  had  practised  medicine  or  surgery  in  the  State  for  ten 
years  next  preceding  the  passage  of  the  act,  nor  to  persons  pre- 
scribing in  their  own  family  {ib.,  s.  6). 

New  Jersey. 

Board  of  Examiners. — The  State  board  of  medical  ex- 
aminers, appointed  hj  the  governor,  consists  of  nine  members, 
persons  of  recognized  professional  ability  and  honor,  five  of  the 
old  school,  three  of  the  homoeopathic,  and  one  of  the  eclectic, 
among  whom  can  be  no  member  of  any  college  or  university 
having  a  medical  department  (Act  1890,  c.  190,  s.  1). 

The  board  must  hold  meetings  for  examination  at  the  capital 
on  the  second  Thursday  of  January",  April,  July,  and  October 
of  each  year  and  at  such  other  times  as  they  deem  expedient ; 
they  shall  keep  a  register  of  all  applicants  for  examination, 
showing  the  name,  age,  and  last  place  of  residence  of  each  can- 
didate, the  time  he  has  spent  in  medical  study  in  or  out  of  a 
medical  school,  the  names  and  locations  of  all  medical  schools 
which  have  granted  the  said  applicant  any  degree  or  certificate 
of  attendance  upon  lectures  in  medicine,  and  whether  the  appli- 
cant has  been  rejected  or  licensed,  and  it  shall  he  prima  facie 
evidence  of  all  matters  contained  therein  {ih.,  s.  2). 

Qualification. — All  persons  commencing  the  practice  of 
medicine  or  surgery  in  anj-  of  its  branches  must  apply  to  the 
board  for  a  license.      Applicants  are  divided  into  three  classes : 

1.  Persons  graduated  from  a  legally  chartered  medical  school 
not  less  than  five  years  before  the  application. 


NEW   JERSEY.  170 

2.  All  other  persons  graduated  from  legally  chartered  med- 
ical schools. 

3.  Medical  students  taking  a  regular  course  of  medical  in- 
struction. 

Applicants  of  the  first  class  are  examined  in  materia  medica, 
therapeutics,  obstetrics,  gynaecology,  practice  of  medicine,  sur- 
gery, and  surgical  anatomy;  those  of  the  second  and  third 
classes  are  examined  in  anatomy,  physiology,  chemistr}-,  ma- 
teria medica,  therapeutics,  histology,  pathology,  hygiene,  prac- 
tice of  medicine,  surger}^,  obstetrics,  gynaecology,  diseases  of 
the  eye  and  ear,  medical  jurisprudence,  and  such  other  branches 
as  the  board  may  deem  advisable ;  questions  for  applicants  of 
the  first  and  second  classes  are  the  same  in  the  branches  com- 
mon to  both.  The  board  after  January  1st,  1892,  cannot  license 
applicants  of  the  second  or  third  classes  without  satisfactory 
proof  that  the  applicant  has  studied  medicine  and  surgery  three 
years,  is  of  good  moral  character,  and  over  twenty-one  years  of 
age ;  applicants  of  the  third  class,  after  they  shall  have  studied 
medicine  and  surgery  at  least  two  years,  can  be  examined  in 
anatomj^,  physiology,  chemistry,  histology,  pathology,  materia 
medica,  and  therapeutics ;  if  the  examination  is  satisfactory^  to 
all  the  members  of  the  board,  it  may  issue  a  certificate  that  the 
applicant  has  passed  a  final  examination  in  these  branches,  and 
such  certificate,  if  presented  by  the  applicant  when  he  shall 
make  application  for  a  license  to  practise,  shall  be  accepted  by 
the  said  board  in  lieu  of  examination  in  those  branches.  All 
examinations  shall  be  both  scientific  and  practical,  but  of  suffi- 
cient severity  to  test  the  candidate's  fitness  to  practise  medicine 
and  surger}'  (?'&.,  s.  3). 

All  examinations  shall  be  in  writing;  the  questions  and 
answers,  except  in  materia  medica  and  therapeutics,  must  be 
such  as  can  be  answered  in  common  by  all  schools  of  practice, 
and  if  the  applicant  intends  to  practise  homoeopathy  or  eclec- 
ticism, the  member  or  members  of  the  said  board  of  those 
schools  shall  examine  the  said  applicant  in  materia  medica  and 
therapeutics ;  if  the  examination  is  satisf actorj^,  the  board  shall 
issue  a  license  entitling  the  applicant  to  practise  medicine.  A 
license  shall  not  be  issued  unless  the  applicant  passes  an  exam- 
ination satisfactory  to  all  members  of  the  board ;  the  examina- 
tion papers  kept  on  file  by  the  secretary  of  the  board  are  prima 


180  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

facie  evidence  of  all  matters  therein  contained ;  on  refusal  of 
the  board  to  issue  a  license  for  failure  on  examination,  the 
applicant  may  appeal  to  the  governor,  who  may  appoint  a  med- 
ical commission  of  review  of  three  members,  one  from  each 
school  of  medicine,  who  shall  examine  the  examination  papers 
of  the  applicant  and  from  them  determine  whether  a  license 
should  be  issued,  and  their  decision  shall  be  final ;  if  the  said 
committee  by  unanimous  vote  reverse  the  determinatioii  of  the 
board,  the  board  shall  issue  a  license ;  the  expenses  of  the  ap- 
peal are  borne  by  the  applicant  {ih.,  s.  4). 

The  board  may,  by  unanimous  vote,  refuse  or  revoke  a 
license  for  chronic  and  permanent  inebriety,  the  practice  of 
criminal  abortion,  conviction  of  a  crime  involving  moral  turpi- 
tude, or  for  publicly  advertising  special  ability  to  treat  or  cure 
disease  which,  in  the  opinion  of  the  said  board,  it  is  impossible 
to  cure. 

In  complaints  for  violating  this  section,  the  accused  shall  be 
furnished  with  a  copy  of  the  complaint  and  giA'en  a  hearing 
before  the  said  board  in  person  or  by  attorney  {ib.,  s.  5). 

A  person  receiving  a  license  must  file  it,  or  a  certified  copy 
thereof,  with  the  clerk  of  the  county  in  which  he  resides ;  and 
in  case  of  removal  into  another  county  he  must  procure  from 
the  said  clerk  a  certified  copy  of  the  said  license,  and  file  it  with 
the  clerk  in  the  countj^  to  which  he  shall  remove  (*7>.,  s.  6). 

Exceptions. — The  act  does  not  appl}^  to  commissioned  sur- 
geons of  the  United  States  army,  navy,  or  marine  hospital  ser- 
vice, or  to  regularly  licensed  phj'-sicians  or  surgeons  in  actual 
consultation  from  other  States  or  Territories,  or  to  regularly 
licensed  physicians  or  surgeons  actually  called  from  other 
States  or  Territories  to  attend  cases  in  this  State,  or  to  any  one 
while  actually  serving  as  a  member  of  the  resident  medical 
staff  of  anj-  legally  incorporated  hospital  or  asylum  in  this 
State,  or  to  any  person  claiming  the  right  to  practise  in  this 
State  who  has  been  practising  therein  since  before  July  4th, 
1890,  provided  the  said  right  or  title  was  obtained  upon  a  di- 
ploma of  which  the  holder  and  applicant  was  lawfully  possessed 
and  it  was  issued  by  a  legally  chartered  medical  institution 
in  good  standing  {ih.,  s.  7,  as  amended  Act  1892,  c.  212). 

Definition. — Any  person  is  regarded  as  practising  medicine 
or  surgery  who  appends  "M.D."  or  "M.B."  to  his  name,  or  pre- 


NEW   JERSEY — NEW   MEXICO-  181 

scribes  for  the  use  of  anj-  person  any  drug  or  medicine  or  odior 
agency  for  the  treatment,  cure,  or  relief  of  any  bodily  injury, 
infirmity,  or  disease  {ih.,  s.  8). 

Penalty. — Commencing  the  practice  of  medicine  or  surgery 
without  a  license  or  contrary  to  the  act  is  a  misdemeanor  pun- 
ishable by  a  fine  of  from  650  to  $100,  or  imprisonment  in  the 
county  jail  from  ten  to  ninety  days,  or  both  {ib.,  s.  0). 

Fees. — To  the  treasurer  of  the  board,  for  examination,  for 
applicant  of  first  and  second  class,  $15. 

To  the  treasurer  of  the  board,  for  examination,  for  applicant 
of  third  class,  $20  (?'6.,  s.  4). 

To  the  county  clerk,  for  registering  license,  50  cents  {ih., 
s.  6). 

New   Hampshire. 
In  New  Hampshire  there  is  no  statute  on  this  subject. 

New  Mexico. 

Board  of  Examiners. — The  board  of  medical  examiners 
is  composed  of  seven  practising  physicians  of  known  abilitj"  and 
integrity,  graduates  of  some  medical  school,  college,  or  uni- 
versity duly  established  under  and  by  virtue  of  the  laws  of  the 
country  in  which  it  is  situated,  four  allopathic  members,  three 
homoeopathic  members,  and  one  eclectic  member  (Compiled 
Laws  1884,  s.  2,553). 

Qualification. — Applications  for  certificates  and  exami- 
nations are  made  to  the  board  through  their  secretary  (?'6.,  s. 
2,555). 

The  board  must  examine  diplomas  as  to  their  genuineness; 
the  verification  consists  in  an  affidavit  of  the  holder  and  appli- 
cant that  he  is  the  lawful  possessor  of  the  diploma  and  the 
person  therein  named ;  the  affidavit  may  be  taken  before  any 
person  authorized  to  administer  oaths,  and  shall  be  attested 
under  his  hand  and  official  seal  if  he  have  a  seal.  Graduates 
may  present  their  diplomas  and  affidavits  by  letter  or  by  proxy 
(^&.,  s.  2,556). 

Examinations  of  persons  not  graduates  or  licentiates  must 
be  made  by  the  board,  and  certificates  by  a  majority  of  the  board 


182  SYNOPSIS  OF   LAWS — POSTE   AND   BOSTON. 

authorize  the  possessor  to  practise  medicine  and  surgery  {ib., 
s.  2,557). 

The  certificate  must  be  recorded  in  the  county  clerk's  office 
in  every  county  in  which  the  holder  practises  or  attempts  to 
practise  medicine  or  surgery  {ib.,  s.  2,558). 

When  a  certificate  is  filed,  the  clerk  must  record  it  and  at- 
tach his  certificate  thereto,  showing  the  date  of  filing  and  re- 
cording and  the  number  of  the  book  and  the  page  of  the 
record  {ib.,  s.  2,559). 

Examinations  of  persons  not  graduates  must  be  made  by 
the  board  and  may  be  wholly  or  partly  in  writing,  in  anatomy, 
physiology,  chemistry,  pathology,  surgery,  obstetrics,  and  the 
practice  of  medicine  (exclusive  of  materia  medica  and  thera- 
peutics) {ib.,  s.  2,561). 

The  board  may  refuse  or  revoke  a  certificate  to  an  individ- 
ual guilt}^  of  unprofessional  or  dishonorable  conduct  {ib.,  s. 
2,562). 

Definition,  Exceptions. — Practising  medicine  is  defined 
as  professing  publicly  to  be  a  physician  and  prescribing  for  the 
sick  or  appending  to  a  name  the  letters  "M.D."  The  act  does 
not  prohibit  students  from  prescribing  under  the  supervision 
of  a  preceptor,  nor  prevent  women  from  practising  midwifery, 
nor  prohibit  gratuitous  services  in  cases  of  emergency',  nor  apph- 
to  commissioned  surgeons  or  acting  surgeons  of  the  United 
States  army  or  navy  {ib.,  s.  2,563). 

Penalty. — Practising  medicine  or  surgery  without  com- 
plying with  the  act  is  punishable  with  a  fine  of  from  650  to 
$500  for  each  offence;  and  filing  a  diploma  or  a  certificate 
of  another,  or  a  forged  affidavit  of  identification,  is  a  felony 
punishable  the  same  as  forgery. 

Exception. — The  provisions  of  the  act  do  not  apply  to  those 
who  have  been  practising  medicine  ten  years  in  the  Territory 
{ib.,  s.  2,564,  Act  passed  1882). 

Professional  Conduct.— The  code  of  ethics  of  the  United 
States  Medical  Association  is  the  standard,  and  the  rule  of  de- 
cision, concerning  professional  conduct  {ib.,  s.  2,565). 

Penalty. — Persons  unlawfully  collecting  or  receiving  fees 
or  compensation  for  services  as  phj^sicians  or  surgeons  in  viola- 
tion of  this  act,  are  liable  to  the  partj^  paying  it  for  double 
the  amount  thereof  {ib.,  s.  2,568). 


NEW   MEXICO — NEW   YORK.  183 

Fees. — To  the  secretary  of  the  board,  from  each  graduate  or 
licentiate  if  the  diploma  is  genuine,  $5. 

To  the  secretary  of  the  board,  from  each  graduate  or 
licentiate  if  the  diploma  is  fraudulent  or  not  owned  by  the  pos- 
sessor, $20  {ib.,  s.  2,556). 

To  clerk  of  the  county,  for  filing  and  recording  certificate, 
the  usual  fees  (ib.,  s.  2,559). 

To  the  secretary  of  the  board,  for  examination,  in  advance, 
$10  {ib.,  s.  3,561). 

New  York. 

Prohibition. — No  person  can  lawfully  practise  medicine 
unless  registered  and  legally  authorized  prior  to  September 
1st,  1891,  or  unless  licensed  by  the  regents  of  the  University 
of  the  State  of  New  York  and  registered  as  required  by  the 
present  law;  nor  can  any  person  lawfully  practise  medicine 
who  has  ever  been  convicted  of  a  felony  by  any  court,  or  whose 
authority  to  practise  is  suspended  or  revoked  by  the  regents  on 
the  recommendation  of  a  State  board  (Laws  of  1893,  c.  661,  s. 
140). 

Boards  of  Examiners. — There  are  three  separate  State 
boards  of  medical  examiners  of  seven  members  each,  represent- 
ing respectively  the  Medical  Society  of  the  State,  the  Homoeo- 
pathic Medical  Society  of  the  State,  and  the  Eclectic  Medical 
Society  of  the  State. 

The  regents  appoint  examiners  from  lists  of  nominees  fur- 
nished by  the  said  societies.  Each  nominee  before  his  appoint- 
ment is  required  to  furnish  to  the  regents  proof  that  he  has 
received  the  degree  of  doctor  of  medicine  from  some  registered 
medical  school,  and  has  legally  practised  medicine  in  this  State 
for  at  least  five  years.  If  no  nominees  are  legally  before  them, 
the  regents  may  appoint  from  the  members  in  good  standing  of 
such  societies  without  restriction  (ib.,  s.  141). 

At  any  meeting  of  the  boards  of  examiners  a  majority  con- 
stitute a  quorum,  but  questions  prepared  by  the  boards  may  be 
grouped  and  edited,  or  answer  papers  of  candidates  may  be 
examined  and  marked,  by  committees  duly  authorized  by  the 
boards  and  by  the  regents  (ib.,  s.  144). 

Qualification. — The  regents  are  required  to  admit  to  ex- 


184  SYNOPSIS   OF  LAWS — POSTE   AND    BOSTON. 

amination  any  candidate  who  pays  a  fee  of  $25,  and  submits 
satisfactory  evidence,  verified  by  oath,  if  required,  that  he — 

(1)  Is  more  than  twenty-one  years  of  age;  (2)  is  of  good 
moral  character ;  (3)  has  the  general  education  required  in  all 
cases  after  August  1st,  1895,  preliminary  to  receiving  the 
degree  of  bachelor  or  doctor  of  medicine  in  this  State ;  (4)  has 
studied  medicine  not  less  than  three  full  years,  including  three 
satisfactory  courses  in  three  different  academic  years  in  a  med- 
ical school  registered  as  maintaining  at  the  time  a  satisfactory 
standard;  (5)  has  either  received  the  degree  of  bachelor  or 
doctor  of  medicine  from  some  registered  medical  school  or  a 
diploma  or  license  conferring  the  full  right  to  practise  medicine 
in  some  foreign  country. 

The  degree  of  bachelor  or  doctor  of  medicine  shall  not  be 
conferred  in  the  State  before  the  candidate  has  filed  with  the 
institution  conferring  it  the  certificates  of  the  regents  that 
three  years  before  the  date  of  his  degree,  or  before  or  during  his 
first  year  of  •  medical  studies  in  the  State,  he  had  either  grad- 
uated from  a  registered  college  or  satisfactorily  completed  not 
less  than  a  three  years'  academic  course  in  a  registered  academy- 
or  high  school ;  or  had  a  preliminary  education  considered  and 
accepted  by  the  regents  as  fully  equivalent ;  or  had  passed  a 
regents'  examination  in  arithmetic,  elementary  English,  geog- 
raphy, spelling.  United  States  history,  English  composition,  and 
physics.  Students  who  had  matriculated  in  a  New  York  med- 
ical school  before  June  5th,  1890,  are  exempt  from  this  pre- 
liminary education  requirement  provided  that  the  degree  be 
conferred  before  August  1st,  1895. 

The  regents  may  in  their  discretion  accept  as  equivalent  for 
anj"  part  of  the  third  and  fourth  requirements  evidence  of  five 
or  more  years'  reputable  practice  of  medicine,  provided  such 
substitution  be  specified  in  the  license  {ib.,  s.  145). 

Each  board  is  required  to  submit  to  the  regents  as  required 
lists  of  suitable  questions  for  a  thorough  examination  in  anat- 
omy, physiology,  and  hygiene,  chemistry,  surgery,  obstetrics, 
pathology  and  diagnosis  and  therapeutics,  including  practice 
and  materia  medica.  From  these  lists  the  regents  are  required 
to  prepare  question  papers  for  all  these  subjects,  which  at  any 
examination  are  required  to  be  the  same  for  all  candidates, 
except  that  in  therapeutics,  practice,  and  materia  medica  all 


NEW   YORK.  185 

questions  submitted  to  any  candidate  shall  be  chosen  from  those 
prepared  by  the  board  selected  by  that  candidate,  and  shall  be 
in  harmony  with  the  tenets  of  that  school  as  determined  by  its 
State  board  of  medical  examiners  {ib.,  s.  140). 

Examinations  for  a  license  are  required  to  be  given  in  at 
Jeast  four  convenient  places  in  this  State  at  least  four  times 
annualh"  in  accordance  with  the  regents'  rules,  and  exclusively 
in  writing  and  in  English.  Each  examination  is  conducted  by 
a  regents'  examiner  who  shall  not  be  one  of  the  medical  exam- 
iners. At  the  close  of  each  examination  the  regents'  examiner 
in  charge  is  required  to  deliver  the  question  and  answer  papers 
to  the  board  selected  by  each  candidate,  or  its  duly  authorized 
committee,  and  such  board,  without  unnecessary  dela}",  is  re- 
quired to  examine  and  mark  the  answers  and  transmit  to  the 
regents  an  official  report  stating  the  standing  of  each  candidate 
in  each  branch,  his  general  average,  and  whether  the  board 
recommends  that  a  license  be  granted.  Such  report  must  in- 
clude the  questions  and  answers  and  is  filed  in  the  public  records 
of  the  university.  If  the  candidate  fails  on  a  first  examination, 
he  may,  after  not  less  than  six  months'  further  stud}",  have  a 
second  examination  without  fee.  If  the  failure  is  from  illness 
or  other  cause  satisfactor}^  to  the  regents  they  may  waive  the 
requirement  of  six  months'  study  {ib.,  s.  147). 

On  receiving  from  a  State  board  an  official  report  that  the 
applicant  has  successfully  passed  the  examinations  and  is  recom- 
mended for  license,  the  regents  are  required  to  issue  to  him,  if 
in  their  judgment  he  is  duly  qualified  therefor,  a  license  to 
practise  medicine.  The  contents  and  execution  of  the  license 
are  regulated  in  detail  by  the  act. 

Applicants  examined  and  licensed  by  other  State  examining 
boards  registered  by  the  regents  as  maintaining  standards  not 
lower  than  those  provided  by  this  article,  and  applicants  who 
matriculated  in  a  New  York  State  medical  school  before  June 
5th,  1890,  and  who  shall  have  received  the  degree  of  "M.D." 
from  a  registered  medical  school  before  August  1st,  1895,  may, 
without  further  examination,  on  the  payment  of  ten  dollars  to 
the  regents,  and  on  submitting  such  evidence  as  they  may  re- 
quire, receive  from  them  an  indorsement  of  their  license  or 
diploma  conferring  all  the  rights  and  privileges  of  a  regents' 
license  issued  after  an  examination. 


186  SYNOPSIS  OF  LAWS — POSTE   AND   BOSTON, 

If  any  person  whose  registration  is  not  legal  because  of 
some  error,  misunderstanding,  or  unintentional  omission  shall 
submit  satisfactory  proof  that  he  had  all  the  requirements  pro- 
vided by  law  at  the  time  of  his  imperfect  registration,  and  was 
entitled  to  be  legally  registered,  he  may,  on  the  unanimous 
recommendation  of  a  State  board  of  medical  examiners,  receive 
from  the  regents  under  seal  a  certificate  of  the  facts,  which  may 
be  registered  by  any  countj^  clerk  and  shall  make  valid  the 
previous  imperfect  registration. 

Before  any  license  is  issued,  it  must  be  numbered  and  re- 
corded in  a  book  in  the  regents'  office,  and  its  number  noted  in 
the  license.  This  record  in  all  legal  proceedings  has  the  same 
weight  as  evidence  that  is  given  to  a  record  of  conveyances  of 
land  {ih.,  s.  148). 

Every  license  to  practise  medicine  is  required,  before  the 
licensee  begins  to  practise,  to  be  registered  in  the  county  clerk's 
office,  where  such  practice  is  to  be  carried  on,  with  his  name, 
residence,  place  and  date  of  birth,  and  the  source,  number,  and 
date  of  his  license.  Before  registering,  each  licensee  is  re- 
quired to  file  an  affidavit  of  the  above  facts,  and  that  he  is  the 
person  named  in  the  license,  and  had,  before  receiving  the  same» 
complied  Avith  all  the  requisites  as  to  attendance,  terms,  and 
amount  of  study  and  examinations  required  by  law  and  the 
rules  of  the  university  as  preliminary  to  the  conferment  thereof ; 
that  no  money  was  paid  for  such  license  except  the  regular  fees 
paid  by  all  applicants  therefor ;  that  no  fraud,  misrepresenta- 
tion, or  mistake  in  any  material  regard  was  employed  by  any 
one  or  occurred  in  order  that  such  license  should  be  conferred. 

Every  license,  or  if  lost  a  copy,  legally  certified  so  as  to  be 
admitted  as  evidence,  or  a  duly  attested  transcript  of  the  record 
of  its  conferment,  shall  before  registration  be  exhibited  to  the 
county  clerk,  who,  only  in  case  it  was  issued  or  indorsed  as  a 
license  under  seal  by  the  regents,  shall  indorse  or  stamp  on 
it  the  date  and  his  name  preceded  by  the  words,  "  Registered 

as  authority  to  practise  medicine   in   the   clerk's   office,  

Count}'."  The  clerk  is  required  thereupon  to  give  to  every 
physician  so  registered  a  transcript  of  the  entries  in  the  register 
with  a  certificate  under  seal  that  he  has  filed  the  prescribed 
affidavit  {ih.,  s.  149). 

A  practising  physician  having  registered  a  lawful  authority 


NEW   YORK.  187 

to  practise  medicine  in  one  countj^  and  removing  such  practice, 
or  a  part  thereof,  to  another  county,  or  regularly  engaged  in 
practice  or  opening  an  office  in  another  county,  must  show  or 
send  by  registered  mail  to  the  clerk  of  such  other  county  his 
certificate*  of  registration.  If  such  certificate  clearly  shows 
that  the  original  registration  was  of  an  authority  issued  under 
seal  by  the  regents,  or  if  the  certificate  itself  is  indorsed  by  the 
regents  as  entitled  to  registration,  the  clerk  is  required  there- 
upon to  register  the  applicant  in  the  latter  county,  and  to  stamp 
or  indorse  on  such  certificate  the  date,  and  his  name  preceded 

by  the  words,  "  Registered  also  in County, "  and  return 

the  certificate  to  the  applicant  {ib.,  s.  150). 

Every  unrevoked  certificate  and  indorsement  of  registration 
is  presumptive  evidence  that  the  person  named  is  legally  regis- 
tered. No  person  can  register  any  authority  to  practise  medi- 
cine unless  issued  or  indorsed  as  a  license  by  the  regents.  No  such 
registration  is  valid  unless  the  authority  registered  constituted 
at  the  time  of  registration  a  license  under  the  laws  of  the  State 
then  in  force.  No  diploma  or  license  conferred  on  a  person  not 
actually  in  attendance  at  the  lectures,  institution,  and  examina- 
tions of  the  school  conferring  the  same,  or  not  possessed,  at  the 
time  of  its  conferment,  of  the  requirements  then  demanded  of 
medical  students  in  this  State  as  a  condition  of  their  being 
licensed,  and  no  registration  not  in  accordance  with  this  article, 
shall  be  lawful  authority  to  practise,  nor  shall  the  degree  of 
doctor  of  medicine  be  conferred  causa  honoris  or  ad  eundiim, 
nor  if  previously  conferred  shall  it  be  a  qualification  for  prac- 
tice {lb.,  s.  151). 

Exceptions. — The  law  does  not  affect  commissioned  medical 
officers  serving  in  the  United  States  army,  navy,  or  marine  hos- 
pital service  while  so  commissioned ;  or  anj^  one  while  actually 
serving  on  the  resident  medical  staff  of  any  legally  incorporated 
hospital;  or  any  legally  registered  dentist  exclusivel}'  engaged 
in  the  practice  of  dentistry ;  or  any  manufacturer  of  artificial 
ej^es,  limbs,  or  orthopaedic  instruments  or  trusses  in  fitting  such 
instruments  on  persons  in  need  thereof ;  or  any  lawfully  qualified 
physician  in  other  States  or  countries  meeting  legally  registered 
physicians  in  this  State  in  consultation  ;  or  any  physician  resid- 
ing on  a  border  of  a  neighboring  State  and  duly  authorized 
under  the  laws  thereof  to  practise  medicine  therein  whose  prac-^ 


188  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

tice  extends  into  this  State,  and  who  does  not  open  an  office  or 
appoint  a  place  to  meet  patients  or  receive  calls  within  this 
State ;  or  any  physician  duly  registered  in  one  county  called  to 
attond  isolated  cases  in  another  county,  but  not  residing  or 
habitually  practising  therein  (ib.,  s.  152). 

Penalty. — A  person  practising  without  lawful  registration 
or  in  violation  of  this  article  forfeits  to  the  county  $50,  for  each 
violation  and  for  every  day  of  unlawful  practice.  To  practise 
under  a  false  or  assumed  name  or  falsely  personate  another 
practitioner  of  like  or  different  name  is  a  felony.  The  violation 
of  the  other  provisions  of  the  act,  or  buying,  selling,  or  fraudu- 
lently obtaining  a  medical  diploma,  license,  record,  or  registra- 
tion, or  aiding  or  abetting  such  buying,  selling,  or  fraudulently 
obtaining,  or  practising  medicine  under  cover  of  a  diploma  or 
license  illegally  obtained,  or  signed  and  issued  unlawfulh'  or 
under  fraudulent  representation  or  misstatement  of  fact  in  a 
material  regard,  or  after  conviction  of  a  felony  attempting  to 
practise  medicine,  or  appending  "M.D."  to  the  name  or  assum- 
ing to  advertise  the  title  of  doctor  in  such  manner  as  to  conve}^ 
the  impression  that  one  is  a  legal  practitioner  of  medicine  or  anj- 
of  its  branches  without  having  legally  received  the  medical 
degree,  is  a  misdemeanor  punishable  with  a  fine  of  not  less  than 
$250,  or  imprisonment  for  six  months  for  the  first  offence,  and 
for  subsequent  offences  with  a  fine  of  not  less  than  $500  or  im- 
prisonment for  not  less  than  one  year,  or  both  fine  and  im- 
prisonment {ib.,  s.  159). 

Definitions. — As  used  in  the  article,  university  means  the 
University  of  the  State  of  New  York.  Medical  school  means 
any  medical  school,  college,  or  department  of  a  university 
registered  b}'  the  regents  as  maintaining  a  proper  medical 
standard  and  as  legally  incorporated.  Medicine  means  medi- 
cine and  surgery;  physician  means  physician  and  surgeon  {ib., 
•definitions). 

Fees. — To  regents,  for  examination,  $25  {ib.,  s.  145). 

To  regents,  for  license  without  examination  under  sec.  148, 
$10  {ib.,  s.  148). 

To  county  clerk,  for  registering  affidavit  and  certificate,  $1 
{ib.,  s.  149). 

To  county  clerk,  for  registration  in  an  additional  county,  25 
•cents  {ib.,  s.  150). 


NEW   YORK— NORTH    CAROLINA.  189 


North  Carolina. 

Qualification. — No  person  can  lawfully  practise  medicine 
or  surgery,  or  any  of  the  branches  thereof,  nor  in  any  case 
prescribe  for  the  cure  of  disease  for  a  fee  or  reward  unless  he 
shall  have  been  first  licensed  (Code  1883,  s.  3,122,  as  amended 
Act  of  1885,  c.  117,  s.  1). 

The  board  of  medical  examiners  of  the  State  consists  of  reg- 
ularly graduated  physicians  appointed  by  the  medical  society  of 
the  State  {ib.,  s.  3,123,  3,12G). 

The  board  must  examine  all  applicants  for  a  license  to  prac- 
tise medicine  or  surgery,  or  any  of  the  branches  thereof,  on 
anatomy,  physiology,  surgery,  pathology,  medical  hygiene, 
chemistry,  pharmac}^,  materia  medica,  therapeutics,  obstetrics, 
and  the  practice  of  medicine,  and  grant  to  a  competent  appli- 
cant a  license  or  diploma  authorizing  him  to  practise  medicine 
and  surgery  or  any  of  the  branches  thereof  {ib.,  s.  3,124). 

Where  he  has  not  been  refused  a  license  hj  the  board,  two 
members  of  the  board  ma}^  grant  a  temporary  license  to  any 
applicant  to  continue  in  force  no  longer  than  the  next  regular 
meeting  of  the  board  {ib.,  s.  3,125,  as  amended  Act  of  1889,  c. 
181,  s.  3). 

The  board  of  examiners  must  assemble  when  and  where  the 
medical  society  assembles,  which  society  must  assemble  at  least 
once  a  year ;  the  board  must  remain  in  session  from  day  to  day 
till  all  applicants  during  the  first  five  days  after  its  meeting- 
have  been  examined  and  disposed  of  {ib.,  s.  3,127). 

Penalty,  Exceptions. — A  person  practising  without  ob- 
taining a  license  from  the  board  shall  not  be  entitled  to  sue  for 
or  recover  any  medical  bill  for  services; -and  a  person  who  has 
begun  the  practice  of  medicine  or  surgery  in  the  Stats  for  a  fee 
or  reward  since  February  23d,  1885,  without  first  obtaining 
such  a  license,  shall  in  addition  be  guilty  of  a  misdemeanor  and 
punishable  with  a  fine  of  from  $25  to  $100,  or  imprisonment  at 
the  discretion  of  the  court  for  each  offence ;  but  the  act  does  not 
apply  to  women  pursuing  the  avocation  of  midwife,  nor  to  any 
reputable  physician  or  surgeon  residing  in  a  neighboring  State, 
coming  into  this  State  for  consultation  with  a  registered  phy- 
sician resident  therein,  except  a  physician  residing  in  a  neigh- 


190  SYNOPSIS   OF   LAWS— POSTE   AND   BOSTON. 

boring  State  regularly  practising  in  this  State,  nor  does  it  apply 
to  physicians  who  have  a  diploma  from  a  regular  medical  college 
priorto  January  1st,  1880  {ib.,  s.  3, 133,  as  amended  Act  of  1885, 
c.  117,  s.  2;  Act  of  1885,  c.  261,  s.  1;  Act  or  1889,  c.  181,  s.  1). 

The  board  may  rescind  a  license  upon  satisfactory  proof 
that  a  licensee  has  been  guilty  of  grossly  immoral  conduct  {ih., 
s.  3,133). 

Qualification. — Every  person  practising  medicine  or  sur- 
gery in  the  State  was  required  before  January  1st,  1892,  to  ap- 
pear personally  before  the  clerk  of  the  superior  court  of  the 
county  where  he  resided  or  practised,  for  registration,  and  all 
persons  beginning  to  practise  are  likewise  to  appear  and  register 
within  thirty  days  after  obtaining  a  license  (Act  of  1889,  c.  181, 
s.  3,  as  amended  Act  of  1891,  c.  90). 

Any  person  applying  for  registration  must  produce  and 
exhibit  before  the  clerk  a  license  from  the  board  of  medical 
examiners,  or  make  oath  that  he  was  practising  medicine  or 
surgery  in  this  State  prior  to  March  7th,  1885,  and  thereupon 
the  clerk  shall  register  the  date,  with  the  name  and  residence 
of  the  applicant,  and  shall  issue  a  certificate  of  registration. 
The  certificate  entitles  the  recipient  to  practise  in  any  county 
in  the  State,  but  if  he  removes  his  residence  to  another  county 
he  must  exhibit  his  certificate  to  the  clerk  of  such  county  and 
be  registered.  Persons  having  a  temporary  license  are  not 
entitled  to  register  but  may  practise  so  long  as  the  license  is  in 
force  (Act  of  1889,  c.  181,  s.  4,  as  amended  Act  of  1891,  c.  420). 

Penalty,  Exceptions. — To  practise  without  registration 
and  a  certificate  is  a  misdemeanor  punishable  with  a  fine  of 
from  $25  to  $100  or  imprisonment  for  each  offence,  but  this  act 
does  not  apply  to  women  pursuing  the  avocation  of  midwife 
nor  to  reputable  physicians  or  surgeons  residing  in  a  neigh- 
boring State  coming  into  the  State  for  consultation  with  a 
registered  physician  of  this  State  (Act  of  1889,  c.  181,  s.  5). 

License  Fee. — A  license  of  $10  for  each  county  in  which  he 
carries  on  business  is  exacted  from  every  (itinerant?)  medical 
practitioner,  one-half  for  the  use  of  the  county  and  one-half  for 
the  use  of  the  State;  but  a  State  license  may  be  obtained  from 
the  State  treasurer  for  $30  good  for  twelve  months,  and  he  is 
then  exempt  from  the  portion  of  above  tax  due  the  State  (Act 
1891,  c.  323). 


NORTH  CAROLINA — NORTH  DAKOTA.  191 

Fees. — To  the  secretary  of  the  board,  before  issuing  a 
license  or  diploma,  610. 

To  the  secretary  of  the  board,  for  temporary  license,  $5 
(Code,  3,130). 

To  clerk  of  the  court,  for  registration  and  certificate,  25 
cents. 

To  clerk  of  the  countj^,  for  registration  on  removal,  no  fee 
(Act  1889,  c.  181,  s.  4). 

North  Dakota. 

Board  of  Examiners. — The  governor  appoints  a  State 
board  of  examiners  of  nine  members,  eight  of  whom  are  practis- 
ing physicians  in  good  standing ;  no  member  of  any  college  or 
university  having  a  medical  department  shall  be  appointed. 
Two  members  shall  be  homoeopathic  physicians  and  one  a 
lawyer  (Act  1890,  c.  93,  s.  1). 

The  board  must  hold  meetings  for  examination  at  such  place 
or  places  as  it  may  designate  on  the  first  Tuesday  of  January, 
April,  July,  and  October  of  each  year,  and  such  other  meetings 
as  it  may  appoint  and  must  keep  a  record  of  its  proceedings 
with  a  register  of  every  applicant  for  a  license  with  his  or  her 
age,  the  time  spent  in  the  study  of  medicine,  and  the  name  and 
location  of  all  institutions  granting  to  such  applicant  a  degree 
or  a  certificate  of  lectures  in  medicine  or  surgery,  and  whether 
the  applicant  was  rejected  or  licensed ;  and  said  books  and  reg- 
ister shall  be  jjrinia  facie  evidence  of  all  matters  therein  re- 
corded (ib.,  s.  2). 

Qualification. — All  persons  hereafter  commencing  the 
practice  of  medicine,  surgery,  and  obstetrics  in  any  of  its 
branches  shall  apply  to  the  board  for  a  license,  and  at  the  time 
and  place  designated  by  the  board,  or  at  its  regular  meeting, 
be  examined  in  anatom}'',  physiology,  chemistry,  histology, 
materia  medica,  therapeutics,  preventive  medicines,  practice  of 
medicine,  surgery,  obstetrics,  diseases  of  women  and  children, 
of  the  nervous  system,  of  the  eye  and  ear,  medical  jurisprudence, 
and  such  other  branches  as  the  board  shall  deem  advisable,  and 
produce  evidence  of  having  attended  three  courses  of  lectures  of 
at  least  six  months  each ;  the  examination  must  be  both  practical 
and  scientific,  but  of  sufficient  severity  to  test  the  candidate's 


192  SYNOPSIS    OP   LAWS — POSTE   AND   BOSTON. 

fitness  to  practise  medicine,  surgery,  and  obstetrics.  When 
desired,  the  said  examination  may  be  conducted  in  the  presence  of 
the  dean  of  any  medical  school  or  the  president  of  any  medical 
society  of  the  State.  After  examination  the  board  must  grant 
a  license  to  practise  medicine,  surgery,  and  obstetrics ;  seven 
members  must  consent.  The  board  may  revoke  or  refuse  a 
license  for  unprofessional,  dishonorable,  or  immoral  conduct, 
chronic  or  persistent  inebriet.y,  the  practice  of  criminal  abortion, 
or  for  publicly  advertising  special  ability  to  treat  or  cure 
diseases  which,  in  the  opinion  of  the  board,  it  is  impossible 
to  cure.  In  complaints  for  violating  the  provisions  of  this 
section,  the  accused  shall  be  furnished  with  a  copy  of  the  com- 
plaint, and  given  a  hearing  before  the  board  in  person  or  by  at- 
torney. Appeal  lies  from  refusal  or  revocation  to  the  appoint- 
ing power  (^6.,  s.  3). 

The  person  receiving  a  license  must  file  it,  or  a  certified 
copy,  with  the  register  of  deeds  where  he  resides.  On  removal 
into  another  county  he  must  procure  from  said  register  a  cer- 
tified copy  of  his  license  and  file  it  with  the  register  of  deeds  in. 
the  county  to  which  he  shall  remove  {ih.,  s.  4). 

Exceptions. — The  act  does  not  apply  to  commissioned  sur- 
geons of  the  United  States  army  or  navy,  to  physicians  or  sur- 
geons in  actual  consultation  from  other  States  or  Territories,  or 
to  actual  medical  students  practising  medicine  under  the  direct 
supervision  of  a  preceptor  {ih.,  s.  5). 

Penalty. — Practising  without  a  license  or  contrary  to  the 
act  is  a  misdemeanor  punishable  with  a  fine  of  from  $50  to 
$200,  or  imprisonment  in  a  county  jail  from  ten  to  sixty  days, 
or  both. 

Definition. — Any  person  is  regarded  as  practising  who  ap- 
pends the  letters  "M.D."  or  "M.B."  to  his  name,  or  who  for 
a  fee  prescribes,  directs,  or  recommends  for  the  use  of  any 
person  any  drug  or  medicine  or  other  agency  for  the  treatment, 
cure,  or  relief  of  any  wound,  fracture  or  bodily  injury,  infirmity, 
or  disease  {ih.,  s.  6). 

Former  Law. — The  former  law  is  repealed  only  so  far  as  it 
is  inconsistent  with  the  foregoing  act  {ih.,  s.  7). 

The  former  law  prohibited  persons  from  practising  medicine 
in  any  of  its  branches  unless  graduates  of  a  medical  college  or 
unless  thej"  were  shown  by  examination  to  be  qualified  and  had 


NORTH   DAKOTA — OHIO.  193 

been  actually  engaged  in  practising  for  at  least  ten  years  (Com- 
piled Laws  of  Dakota,  s.  205). 

Fee.*— To  the  treasurer  of  the  board,  for  examination,  S20 
(Act  1890,  c.  93,  s.  3). 

Ohio. 

Qualification. — No  person  who  is  not  a  graduate  of  a 
reputable  school  of  medicine  in  the  United  States  or  a  foreign 
country,  or  who  cannot  produce  a  certificate  of  qualification 
from  a  State  or  county  medical  society  and  is  not  a  person  of 
good  moral  character,  can  lawfully  practise  or  attempt  to 
practise  medicine  in  any  of  its  departments  or  prescribe  medi- 
cine for  reward  or  compensation ;  except  a  person  who  has  been 
continuously  engaged  in  the  practice  of  medicine  for  ten  years 
or  more.  The  law  allowed  persons  in  continuous  practice  for 
five  years  or  more,  two  years  to  comply  with  its  provisions.  In 
case  a  person  is  a  graduate  of  a  school  of  medicine  in  any  State 
or  foreign  countrj'  in  which  any  condition  or  restriction  is  im- 
posed by  law  upon  the  practice  of  medicine  by  graduates  of  med- 
ical schools  in  Ohio,  he  is  subject  to  the  same  restrictions  or  con- 
ditions. A  person  violating  this  section  is  not  entitled  to  any 
compensation  for  services  (Smith  &  Benedict's  Revised  Statutes 
of  1890,  s.  4,403). 

Penalty. — Whoever  prescribes  or  practises  or  attempts 
to  practise  medicine  in  any  of  its  departments,  or  performs  or 
attempts  to  perform  a  surgical  operation  without  having  attended 
two  full  courses  of  instruction  and  graduated  at  a  school  of 
medicine  either  in  this  or  a  foreign  country,  or  who  cannot 
produce  a  certificate  of  qualification  from  a  State  or  county  med- 
ical society,  except  a  person  who  has  been  continuous^  en- 
gaged in  the  practice  of  medicine  for  ten  years  or  more,  is  pun- 
ishable with  a  fine  of  from  $50  to  $100  and  for  a  subsequent 
offence  with  imprisonment  for  thirtj^'  days.  Persons  in  con- 
tinuous practice  for  five  years  or  more  were  allowed  two  years 
to  comply  with  this  act  (^6.,  s.  6,992). 

Oklahoma. 

Qualification. — No  person  can  lawfully  practise  medicine 
in  any  department  unless  he  be  a  graduate  of  a  medical  college, 
or  unless  upon  examination  before  a  board  composed  of  the 
13 


194  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

superintendent  of  public  health  and  two  other  phj'sicians  to  be 
selected  by  the  territorial  board  of  health,  he  be  found  proficient 
in  the  practice  of  medicine  and  surgery,  and  shall  be  found 
upon  proof  to  have  been  actually  engaged  in  the  practice  of 
medicine  not  less  than  five  years.  No  person  shall  practise 
medicine  unless  he  be  of  good  moral  character,  and  is  not  an 
habitual  drunkard. 

A  person  possessing  these  qualifications  shall,  on  presenta- 
tion of  his  diploma,  or  proof  thereof  by  affidavit  if  it  be  lost  or 
destroyed,  and  the  affidavit  of  two  reputable  citizens  from  the 
county  where  he  resides  that  the  applicant  possesses  the  quali- 
fications of  a  physician,  as  prescribed  herein,  to  the  superin- 
tendent of  public  health,  receive  from  him  a  license,  which  shall 
be  recorded  in  the  office  of  the  register  of  deeds  in  the  county 
where  such  physician  resides. 

Offence. — To  practise  without  complying  with  this  law, 
or  to  violate  any  of  its  provisions,  is  a  misdemeanor. 

Definition. — A  person  is  regarded  as  practising  medicine 
who  professes  publicly  to  be  a  ph^-sician  and  to  prescribe  for 
the  sick,  or  who  appends  to  his  name  M.D. 

Exceptions. — The  law  does  not  prohibit  students  from  pre- 
scribing under  the  supervision  of  preceptors,  nor  prohibit  gra- 
tuitous services  in  case  of  emergency,  nor  apply  to  commis- 
sioned surgeons  in  the  United  States  army  and  navy. 

Cancellation  of  License. — The  district  court  has  power 
on  complaint  of  a  member  of  the  territorial  board  of  health,  or 
the  county  board  of  health  where  he  resides,  to  cancel  any 
license  issued  to  a  person  to  practise  medicine,  where  such 
license  was  fraudulently  obtained,  or  where  the  person  to  whom 
it  was  issued  has  been  guilty  of  violating  any  provision  of  this  act. 

Fee.^ — To  superintendent  of  board  of  health,  for  license,  82 
(Comp.  Stats.,  1893,  s.  352). 

Oregon. 

Qualification. — Every  person  practising  medicine  and 
surgery  in  any  of  their  departments  must  possess  the  qualifica- 
tions required  by  the  act.  If  a  graduate  of  medicine  he  must 
present  his  diploma  to  the  board  of  examiners  for  verification 
as  to  its  genuineness.     If  found  genuine  and  the  person  named 


OKLAHOMA— OREGON.  195 

therein  be  the  person  claiming  and  presenting  the  same,  the 
board  issues  its  certificate,  which  is  conchisive.  If  not  a 
graduate,  he  must  submit  to  an  examination  as  the  board  shall 
require,  and  if  the  examination  be  satisfactory  the  board  issues 
its  certificate,  and  the  lawful  holder  is  entitled  to  all  the  rights 
and  privileges  mentioned  in  the  act  (Act  February  28th,  1889, 
s.  1). 

The  governor  appoints  three  persons  from  among  the  most 
competent  phj'siciaus  of  the  State,  residents  of  the  State  for 
seven  years  and  of  at  least  five  years'  practical  experience  in 
their  profession,  to  be  the  board  of  examiners  {ib.,  s.  2). 

The  board  must  issue  certificates  to  all  who  furnish  satisfac- 
tory proof  of  having  received  a  diploma  or  license  from  a 
legally  chartered  medical  institution  in  good  standing  of  what- 
ever school  of  medicine,  and  they  are  not  permitted  to  make 
discrimination  against  holders  of  a  general  license  or  diploma 
under  anj^  school  or  system  of  medicine  in  good  standing  {ib., 
s.  3,  as  amended  February  21st,  1891). 

The  verification  of  a  diploma  consists  in  an  affidavit  of  the 
holder  and  applicant  that  he  is  the  person  therein  named,  taken 
before  any  person  authorized  to  administer  oaths,  attested 
under  the  hand  and  official  seal  of  the  official,  if  he  have  a  seal; 
graduates  may  present  their  diplomas  and  affidavits  by  letter  or 
proxy.  The  act  allows  persons  taking  advantage  of  section  13 
ninety  days  after  its  passage  in  which  to  procure  a  certificate 
{ib.,  s.  4,  as  amended  February  21st,  1891). 

All  examinations  of  persons  not  graduates  or  licentiates 
must  be  made  directly  by  the  board,  and  certificates  authorize 
the  person  named  to  practise  medicine  and  surgery  {ib.,  s.  5). 

The  holder  of  a  certificate  must  have  it  recorded  in  the  office 
of  the  county  clerk  of  the  county  in  which  he  resides,  and  the 
record  must  be  indorsed  thereon.  On  removal  to  another  county 
to  practise  he  must  procure  an  indorsement  to  that  effect  on  the 
certificate  from  the  clerk,  and  have  the  certificate  recorded  in 
the  office  of  the  clerk  of  the  county  to  which  he  removes  {ib., 
s.  6). 

The  examinations  may  be  wholly  or  partly  in  writing  and 
must  be  of  an  elementarj-  and  practical  character,  but  suffi- 
ciently strict  to  test  the  qualifications  of  the  candidate  as  a 
practitioner  {ib.,  s.  8). 


196  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

The  board  may  refuse  a  certificate  to  an  individual  guilty  of 
unprofessional  or  dishonorable  conduct,  and  may  revoke  for 
like  causes,  after  giving  the  accused  an  opportunity  to  be  heard 
in  his  defence  before  the  board  {ib.,  s.  9). 

Definition,  Exceptions. — An}-  person  is  regarded  as  prac- 
tising medicine  who  professes  publicly  to  be  a  physician  and  to 
prescribe  for  the  sick,  or  appends  to  his  name  the  letters 
"  M.D. ;"  but  the  act  does  not  prohibit  students  from  prescribing 
under  the  supervision  of  a  preceptor,  nor  gratuitous  services  in 
cases  of  emergency,  nor  does  it  apply  to  commissioned  surgeons 
of  the  United  States  army,  navy,  and  marine  hospital  service 
{ib.,  s.  10). 

Itinerant  Vender. — Any  itinerant  vender  of  any  drug, 
nostrum,  medicine,  ointment,  or  appliance  of  any  kind  intended 
for  the  treatment  of  disease  or  injury,  who  shall  publicly  profess 
to  cure  or  treat  diseases,  injuries,  deformities,  or  ailments  by 
any  drug,  nostrum,  medicine,  or  other  appliance,  shall  pay  a 
license  to  the  Secretary  of  the  State  of  8100  per  month. 

Violation  of  this  section  is  a  misdemeanor  punishable  by  a 
fine  of  not  more  than  $500  or  imprisonment  in  a  county  jail  for 
not  more  than  six  months,  or  both.  Such  licenses  to  any  firm 
or  company  do  not  permit  the  transaction  of  business  in  differ- 
ent places  at  the  same  time  {ib.,  s.  11,  as  amended  February 
21st,   1891). 

Penalty. — Practising  medicine  or  surgery  without  com- 
plying with  the  act  is  a  misdemeanor  punishable  with  a  fine  of 
from  $50  to  $500  or  imprisonment  in  a  county  jail  from  thirt}' 
days  to  three  hundred  and  sixty-five  days,  or  both,  for  each 
offence.  Filing  or  attempting  to  file  as  his  own  the  certificate 
of  another,  or  a  forged  affidavit  or  identification,  is  a  felony 
punishable  the  same  as  forgery  in  the  second  degree  {ib.,  s.  12). 

Former  Practitioners. — Persons  practising  in  the  State 
at  the  time  of  the  passage  of  the  act  were  allowed  sixty  days 
afterward  to  register  {ib.,  s.  13). 

Fees. — To  the  secretary  of  the  board,  for  examining  a  genu- 
ine diploma,  $1. 

To  the  secretary-  of  the  board,  for  examining  a  fraudulent 
diploma,  or  a  diploma  not  owned  b}^  the  possessor,  $20  {ib.,  s.  4). 

To  the  county  clerk,  for  recording  certificate,  usual  fee  {ib.y 
s.  6). 


OREGON — PENNSYLVANIA.  197 

To  board  of  examiners,  for  examination,  $10  {ib.,  s.  8). 

To  the  Secretarj^  of  the  State,  from  itinerant  vender,  for 
license,  $100  per  month  {ib.,  s.  11,  as  amended  February  21st, 
1891). 

Pennsylvania. 

[Present  Law. — The  following  is  the  law  at  present  in 
effect ;  for  the  new  law  which  goes  into  effect  hereafter,  see 
below.] 

Qualification. — The  standard  of  a  practitioner  of  medi- 
cine, surgery,  or  obstetrics  consists  of  a  good  moral  character, 
a  thorough  elementary  education,  a  comprehensive  knowledge 
of  human  anatomy,  human  physiology,  pathology,  chemistry, 
materia  medica,  obstetrics,  and  practice  of  medicine  and  sur- 
gery and  public  hygiene  (Act  March  24th,  1877,  s.  1). 

It  is  unlawful  for  any  person  to  announce  himself  as  a  prac- 
titioner of  medicine,  surgery-,  or  obstetrics,  or  to  practise  as  such, 
who  has  not  received  in  a  regular  manner  a  diploma  from  a 
chartered  medical  school,  duly  authorized  to  confer  upon  its 
alumni  the  degree  of  doctor  of  medicine.  The  act  does  not 
apply  to  a  resident  practitioner  who  has  been  in  continuous 
practice  in  the  commonwealth  for  not  less  than  five  years  prior 
to  its  passage  {ib.,  s.  2). 

Before  any  person  can  lawfully  engage  in  the  practice  of 
medicine,  surgery,  or  obstetrics,  or  who  has  not  a  diploma  as 
provided  in  sec.  2,  he  must  make  an  affidavit  under  oath,  or 
affirm  before  the  prothonotary  of  the  county  in  which  he  in- 
tends to  practise,  setting  forth  the  time  of  continuous  practice 
and  the  place  or  places  where  such  practice  was  pursued  in 
the  commonwealth,  and  it  shall  be  entered  of  record  {ib.,  s.  3). 

Transient  Practitioner. — Any  person  attempting  to 
practise  medicine  or  surgery  for  a  valuable  consideration  by 
opening  a  transient  office  within  the  commonwealth,  or  by 
handbill  or  other  form  of  written  or  printed  advertisement, 
assigning  such  transient  office  or  other  place  to  persons  seeking 
medical  or  surgical  advice,  or  prescribing  or  itinerating  from 
place  to  place  or  from  house  to  house  and  proposing  to  cure 
any  person  sick  or  afflicted,  by  the  use  of  any  medicine,  means, 
or  agency  whatsoever,  for  a  valuable  consideration,  shall  before 
being  allowed  to  practise  in  this  manner  appear  before  the  clerk 


198  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

of  the  court  of  quarter  sessions  of  the  county  where  he  desires 
to  practise  and  furnish  satisfactory  evidence  to  such  clerk  that 
this  act  has  been  complied  with,  and  shall  take  out  a  license  for 
one  year  and  pay  $50  therefor  {ib.,  s.  4). 

Penalty. — To  violate  this  act  is  a  misdemeanor  punishable 
with  a  fine  of  from  $200  to  $400  for  each  offence  (ib.,  s.  5). 

Qualification. — Every  person  who  shall  practise  medicine 
or  surgery,  or  any  of  their  branches,  for  gain,  or  shall  receive 
or  accept  for  his  services  any  fee  or  reward  directly  or  indirectly, 
shall  be  a  graduate  of  a  legally  chartered  medical  college  or  uni- 
versity having  authority  to  confer  the  degree  of  doctor  of 
medicine  (except  as  provided  in  sec.  5) ,  and  shall  present  to  the 
prothonotary  of  the  county  in  which  he  resides  or  sojourns  his 
medical  diploma  as  well  as  a  true  copy  of  the  same,  includ- 
ing any  indorsements  thereon,  and  make  affidavit  before  him 
that  the  diploma  and  indorsements  are  genuine ;  thereupon  the 
prothonotary  shall  enter  in  the  register  the  name  in  full  of 
the  practitioner,  his  place  of  nativity,  place  of  residence,  the 
name  of  the  college  or  university  that  has  conferred  the  degree 
of  doctor  of  medicine,  the  year  when  it  was  conferred,  and  in 
like  manner  any  other  degree  or  degrees  that  the  .practitioner 
may  desire  to  place  on  record ;  to  all  of  which  the  practitioner 
shall  make  affidavit  before  the  prothonotar}-  and  the  prothono- 
tary shall  place  the  copy  of  the  diploma  and  indorsements  on 
file  (Act  June  8th,  1881,  s.  2). 

Any  person  whose  medical  diploma  has  been  destroyed  or 
lost  shall  present  to  the  prothonotar}^  of  the  county  in  which  he 
resides  or  sojourns  a  duly  certified  copy  of  his  diploma,  but  if 
the  same  is  not  obtainable  a  statement  of  this  fact,  with  the 
names  of  the  professors  whose  lectures  he  attended  and  the 
branches  of  study  upon  which  each  professor  lectured,  to  all  of 
which  the  practitioner  shall  make  affidavit  before  the  prothono- 
tarj^ ;  after  which  the  practitioner  shall  be  allowed  to  register 
and  the  prothonotary  shall  place  such  certificate  or  statement 
on  file  {ib.,  s.  3). 

Any  person  desiring  to  commence  the  practice  of  medicine 
or  surger}',  having  a  medical  diploma  issued  by  any  college, 
university,  society,  or  association  in  another  State  or  foreign 
country,  shall  lay  the  same  before  the  faculty  of  one  of  the 
medical  colleges  or  universities  of  this  commonwealth  for  in- 


PENNSYLVANIA.  199 

spection,  and  the  faculty  being  satisfied  as  to  the  qualifications 
of  the  applicant  and  the  genuineness  of  the  diploma  shall  direct 
the  dean  of  the  facult}'  to  indorse  the  same,  after  which  such  per- 
son shall  be  allowed  to  register  as  required  by  sec.  2  {ib.,  s.  4). 

The  act  extends  the  privilege  of  continuing  to  practise  to 
those  who  have  been  in  the  continuous  practice  of  medicine  or 
surgery  in  the  commonwealth  since  1871,  but  such  a  person 
must  make  aSidavit  to  a  written  statement  of  the  facts  before 
the  prothonotary  of  the  county  in  which  he  resides ;  and  the 
prothonotary  shall  enter  in  the  register  the  name  in  full  of  the 
jiractitioner,  his  place  of  nativit}',  place  of  residence,  the  time 
of  continuous  practice  in  the  commonwealth,  and  the  place  or 
places  where  such  practice  was  pursued,  to  all  of  which  the 
practitioner  shall  make  affidavit,  and  the  prothonotary  shall 
place  the  certificate  or  statement  on  file  in  his  office  {ih.,  s.  5). 

Penalty. — Presenting  to  the  faculty  of  an  institution  for 
indorsement  or  to  the  prothonotary  a  diploma  which  has  been 
obtained  by  fraud,  or  in  whole  or  in  part  a  forgery,  or  making 
an  affidavit  to  a  false  statement,  or  practising  without  conform- 
ing with  the  act,  or  otherwise  violating  or  neglecting  to  comply 
with  the  act,  is  a  misdemeanor  punishable  with  a  fine  of  6100 
or  imprisonment  in  the  county  jail  for  not  more  than  one  3'ear, 
or  both,  for  each  offence  {ib.,  s.  7). 

Exception. — The  act  does  not  prevent  any  physician  or 
surgeon,  legally  qualified  to  practise  medicine  or  surgery  in  the 
State  where  he  resides,  from  practising  in  the  commonwealth, 
but  a  person  opening  an  office  or  appointing  a  place  to  meet 
patients  or  receive  calls  is  a  sojourner  and  must  conform  to  its 
requirements  {ib.,  s.  8). 

Fees.  — To  the  prothonotary,  for  affidavit  of  continuous  prac- 
tice, $2  (Act  March  24th,  1877,  s.  3). 

To  count}'  treasurer,  for  transient  license,  $50. 

To  clerk  of  the  court  of  quarter  sessions,  for  issuing  tran- 
sient license,  $5  {ib.,  s.  4). 

To  the  prothonotary,  for  registration,  $1  (Act  June  8th, 
1881,  s.  6). 

[New  Law. — The  following  law  has  been  enacted  whose 
practical  application  does  not  begin  until  March  1st,  1894 :] 

Medical  Council. — The  law  provides  for  a  medical  council 
of  the  State  (Act  of  May  18th,  1893,  s.  1). 


:;iOO  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

The  council  is  to  supervise  the  examinations  conducted  by 
the  State  boards  of  medical  examiners  for  licenses  to  practise 
medicine  and  surgery,  and  issue  licenses  to  applicants  who  shall 
have  presented  satisfactory  and  properly  certified  copies  of 
licenses  from  the  State  boards  of  medical  examiners  or  State 
boards  of  health  of  other  States,  or  who  shall  have  successfully 
passed  the  examination  of  one  of  the  State  boards  established  by 
this  act  {lb.,  s.  5). 

Medical  Boards. — From  and  after  March  1st,  1894,  there 
are  to  be  three  separate  boards  of  medical  examiners,  one  repre- 
senting the  medical  society  of  the  State,  one  representing  the 
homoeopathdc  medical  society  pf  the  State,  and  one  representing 
the  eclectic  medical  society  of  the  State.  Each  board  is  to  consist 
of  seven  members  appointed  by  the  governor  from  the  full  lists 
of  the  members  of  the  said  medical  societies,  and  is  to  be  com- 
posed exclusiveh^  of  members  of  the  same  medical  society. 
Each  appointee  must  be  a  registered  physician  in  good  stand- 
ing, and  shall  have  practised  medicine  or  surgery  under  the  laws 
of  the  State  for  not  less  than  ten  years  prior  to  his  appointment. 

The  governor  is  to  fill  vacancies  and  ma}'  remove  a  member 
for  continual  neglect  of  duties  or  on  the  recommendation  of  the 
medical  society  with  which  he  may  be  in  aflfiliation,  for  unpro- 
fessional or  dishonorable  conduct  {ih.,  s.  6). 

Examinations. — For  the  purpose  of  examining  applicants 
each  board  is  to  hold  two  or  more  stated  or  special  meetings  in 
each  year  after  due  public  notice.  A  majority  constitutes  a 
quorum,  but  the  examination  may  be  conducted  by  a  committee 
of  one  or  more  members  authorized  by  the  board  {ih.,  s.  9). 

The  boards  not  less  than  one  week  prior  to  each  examination 
must  submit  to  the  council  questions  for  thorough  examination 
in  anatomy,  physiology,  hygiene,  chemistry,  surgery,  obstetrics, 
pathologj-^,  diagnosis,  therapeutics,  practice  of  medicine,  and 
materia  medica ;  and  the  council  must  select  therefrom  the  ques- 
tions for  each  examination,  and  such  questions  for  each  exam- 
ination shall  be  the  same  for  all  candidates,  except  that  in  the 
departments  of  therapeutics,  practice  of  medicine,  and  materia 
medica  the  questions  shall  be  in  harmony  with  the  teachings 
of  the  school  selected  by  the  candidate  {ih.,  s.  10). 

The  examinations  are  to  be  in  writing  under  rules  pre- 
scribed b}-  the  council.     After  an  examination  the  board  must 


PENNSYLVANIA.  201 

act  on  it  without  unnecessary  delay  and  transmit  to  the  council 
an  official  report  of  its  action  stating  the  examination  average 
of  each  candidate  in  each  branch,  the  general  average,  and  the 
result,  and  whether  successful  or  unsuccessful.  The  report 
must  embrace  all  the  examination  papers,  questions,  and  an- 
swers, which  shall  be  kept  for  reference  and  inspection  for  not 
less  than  five  years  (^7>.,  s.  11). 

Qualification. — The  council  must  forthwith  issue  to  each 
applicant  returned  as  having  successfully  passed  said  examina- 
tion, and  adjudged  by  the  council  to  be  duly  qualified,  a  license 
to  practise  medicine  and  surgery.  The  council  must  require  the 
same  standard  of  qualifications  from  all  candidates  except  in 
therapeutics,  practice  of  medicine,  and  materia  medica,  in  which 
the  standard  shall  be  determined  by  the  boards  respectively. 
Before  the  license  is  issued,  it  must  be  recorded  in  a  book  in 
the  office  of  the  council,  and  the  number  of  the  book  and  page 
containing  the  record  noted  on  the  face  of  the  license;  the 
records  shall  have  the  same  weight  as  evidence  as  that  given  to 
conveyance  of  land  (ib.,  s.  12). 

On  and  after  July  1st,  1894,  any  person  not  theretofore 
authorized  to  practise  medicine  and  surgery  in  the  State  may 
deliver  to  the  secretar}^  of  the  council  a  written  application  for 
a  license  with  satisfactory  proof  that  the  applicant  is  more  than 
twenty-one  years  of  age,  is  of  good  moral  character,  has  ob- 
tained a  competent  common-school  education,  and  has  received 
a  diploma  conferring  the  degree  of  medicine  from  some  legally 
incorporated  medical  college  of  the  United  States,  or  a  diploma 
or  license  conferring  the  full  right  to  practise  all  the  branches 
of  medicine  and  surgery  in  some  foreign  country.  Applicants 
who  have  received  their  degree  in  medicine  after  July  1st,  1894, 
must  have  pursued  the  study  of  medicine  for  at  least  three 
years,  including  three  regular  courses  of  lectures  in  different 
years  in  some  legally  incorporated  medical  college  or  colleges 
prior  to  the  granting  of  said  diploma  or  foreign  license.  Such 
proof  shall  be  made,  if  required,  upon  affidavit,  and  if  the  coun- 
cil is  satisfied  with  the  same  it  shall  issue  to  the  applicant  an 
order  for  examination  before  such  one  of  the  boards  of  exami- 
ners as  the  applicant  may  select.  In  case  of  failure  at  the  exam- 
ination the  candidate,  after  the  expiration  of  six  months  and 
within  two  j^ears,  shall  have  the  privilege  of  a  second  exami- 


202  SYNOPSIS   OP   LAWS — POSTE   AND    BOSTON. 

nation  by  the  same  board  without  additional  fee.  Applicants 
examined  and  licensed  by  State  boards  of  medical  examiners  or 
State  boards  of  health  of  other  States,  on  filing  in  the  office  of 
the  medical  council  a  copy  of  said  license  certified  by  the  affi- 
davit of  the  president  and  secretary  of  such  board,  showing 
also  that  the  standard  of  acquirements  adopted  by  said  board  is 
substantially  the  same  as  is  provided  by  sees.  11,  12,  and  13  of 
this  act,  shall  without  further  examination  receive  a  license 
conferring  on  the  holder  all  the  rights  and  privileges  provided 
by  sees.  14  and  15  (ib.,  s.  13). 

From  and  after  March  1st,  1894,  no  person  shall  enter  upon 
the  practice  of  medicine  or  surgery  unless  he  has  complied  with 
this  act  and  shall  have  exhibited  to  the  prothonotary  of  the 
court  of  common  pleas  of  the  county  in  which  he  desires  to 
practise  a  license  duly  granted,  which  shall  entitle  him  to  be 
duly  registered  in  the  office  of  such  prothonotar3\ 

Penalty. — Violating  the  provisions  of  this  act  shall  be  a 
misdemeanor  punishable  with  a  fine  of  not  more  than  $500  for 
each  offence  {tb.,  s.  14). 

Exceptions. — The  act  does  not  interfere  with  or  punish 
commissioned  medical  officers  serving  in  the  army  or  navy  of  the 
United  States,  or  its  marine  hospital  service,  while  so  com- 
missioned, or  medical  examiners  of  relief  departments  of  railroad 
companies,  while  so  employed,  or  any  one  while  actually  serv- 
ing as  a  member  of  the  resident  medical  staff  of  any  legally  in- 
corporated hospital,  or  any  legally  qualified  and  registered  dentist 
exclusively  engaged  in  the  practice  of  dentistry,  nor  interfere* 
with  or  prevent  the  dispensing  and  sale  of  medicine  or  med- 
ical appliances  by  apothecaries  [or]  pharmacists,  nor  interfere 
with  the  manufacture  of  artificial  eyes,  limbs,  or  orthopsedical 
instruments  or  trusses  of  any  kind  for  (sic)  fitting  such  instru- 
ments on  persons  in  need  thereof,  or  any  lawfully  qualified  phy- 
sicians and  surgeons  residing  in  other  States  or  countries  meet- 
ing registered  physicians  of  this  State  in  consultation,  or  any 
physician  or  surgeon  residing  on  the  border  of  a  neighboring 
State  and  duly  authorized  under  the  laws  thereof  to  practise 
medicine  and  surger}^  therein,  whose  practice  extends  into  the 
limits  of  this  State,  provided  such  practitioner  shall  not  open 
an  office  or  appoint  a  place  to  meet  patients  or  receive  calls 
within  the  limits  of  Pennsylvania,  or  physicians  duly  registered 


PENNSYLVANIA — RHODE  ISLAND — SOUTH  CAROLINA.       203^ 

in  one  county  of  this  State  called  to  attend  cases  in  another, 
but  not  residing  or  ojDening  an  office  therein. 

The  act  does  not  prohibit  the  practice  of  medicine  and  sur- 
gery by  any  practitioner  who  shall  have  been  duly  registered 
before  March  1st,  1894,  according  to  the  Act  of  June  8th,  1881, 
and  one  such  registration  shall  be  sufficient  warrant  to  practise 
medicine  and  surgery  in  any  county  {ih.,  s.  15). 

Former  Laws. — All  acts  or  parts  of  acts  inconsistent  with 
this  are  repealed  («6.,  s.  17). 

Fees. — To  the  secretary  of  the  council,  upon  application  for 
a  license,  $25. 

To  the  secretary  of  the  county,  upon  application  for  a 
license  by  licensees  in  other  States,  $15  (i6.,  s.  1.3). 

To  the  prothonotary,  upon  exhibition  of  a  license,  for  reg- 
istry, $1  {ih.,  s.  14). 

Rhode  Island. 

Registration. — Every  physician  must  cause  his  name  and 
residence  to  be  recorded  in  the  town  clerk's  office  of  the  town 
where  he  resides  (Public  Statutes,  1882,  c.  85,  s.  12). 

Penalty.  — Wilful  neglect  or  refusal  to  perform  this  duty  is 
punishable  with  a  fine  not  exceeding  $20  {ih.,  s.  11). 

South  Carolina. 

Qualification. — All  physicians  engaging  in  the  practice 
of  ^nedicine  or  surgery,  before  doing  so,  must  submit  their  di- 
plomas to  a  board  consisting  of  three  reputable  physicians  in 
each  county.  The  board  is  appointed  by  the  governor  on  the  rec- 
ommendation of  the  medical  societies  of  the  counties,  and 
where  no  medical  society  exists,  upon  the  recommendation  of 
the  senator  and  members  of  the  House  of  Representatives  for 
such  counties  (Act  of  1890,  c.  454,  s.  1). 

The  said  board  must  examine  said  diploma,  when  submitted, 
and  if  the  holder  is  a  hona  fide  holder,  and  if  the  college  issu- 
ing said  diploma  is  a  reputable  medical  college,  and  if  he  also 
submits  a  certificate  of  good  moral  character,  the  board  must 
certify  to  the  fact,  and  upon  such  certificate  the  diploma  shall 
be  registered  by  the  clerk  of  the  court  of  the  county  in  which 
the  applicant  resides  (/&.,  s.  2). 


204  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

Exception. — The  act  does  not  apply  to  physicians  and  sur- 
geons ah-eady  registered  under  former  laws  {ib.,  s.  4). 

South  Dakota, 

Prohibition. — It  is  unlawful  for  any  person  to  practise 
medicine,  surgery,  or  obstetrics  in  any  of  their  dejoartments 
without  having  received  a  license  to  practise  medicine  from 
the  board  of  health,  and  having  it  recorded  in  the  office  of  the 
register  of  deeds  in  the  county  where  such  person  resides  (Act 
February  16th,  1893,  s.  1). 

Exceptions. — The  act  does  not  affect  those  in  the  lawful 
practice  of  medicine,  surger}',  or  obstetrics  in  this  State  at  the 
time  of  its  passage  {ib.,  s.  2). 

Nor  does  it  prohibit  students  from  prescribing  under  the 
supervision  of  a  preceptor,  nor  prohibit  gratuitous  services  in 
case  of  emergency,  nor  apply  to  commissioned  surgeons  in  the 
United  States  army  and  navj-  {ib.,  s.  3). 

Penalty. — Violation  of  the  act  or  practising  without  the 
license  is  a  misdemeanor  punishable  with  a  fine  of  from  825  to 
$100  or  imprisonment  in  the  county  jail  not  more  than  thirty 
days  or  both  {ib.,  s.  4). 

Qualification. — The  State  board  of  health  is  constituted 
a  board  of  public  examiners  ex-officio  to  examine  and  license 
phj^sicians  to  practise  medicine.  Any  person  who  is  a 
graduate  of  a  lawful  medical  college,  who  has  attended  three 
full  courses  of  medical  lectures  of  six  months  each,  no  ^wo 
full  courses  within  the  same  year,  and  who  is  of  good  moral 
character,  and  is  not  an  habitual  drunkard,  shall,  upon  proof  of 
such  facts  to  the  superintendent  of  the  State  board  of  health, 
as  the  board  shall  require,  receive  from  said  superintendent  a 
license;  which  shall  be  recorded  as  above.  The  requirement 
of  three  courses  of  lectures  does  not  apply  to  those  who  had 
graduated  prior  to  the  passage  of  the  act  {ib.,  s.  5). 

Cancellation  of  License.— The  State  board  of  health, 
upon  complaint  made  to  it  on  oath  by  one  responsible  person, 
has  power  to  cancel  any  license  that  may  have  been  fraudulently 
obtained  or  when  the  person  to  whom  such  license  was  issued 
is  an  habitual  drunkard,  or  is  guilty  of  immoral  practices  or 
gross  unprofessional  conduct.     Such   license   shall  not  be  can- 


SOUTH   DAKOTA — TENNESSEE.  205 

celled  except  after  a  hearing  before  such  board  of  health,  at 
which  a  majority  of  such  board  shall  be  present,  and  of  which 
the  person  holding  the  license  to  be  cancelled  shall  have  had 
at  least  ten  days'  notice,  and  only  upon  due  proof  of  the  facts 
stated  in  the  complaint.  An  appeal  may  be  taken  to  the  circuit 
court  of  the  county  in  which  the  person  whose  license  is  can- 
celled lives  by  any  person  aggrieved,  in  the  same  manner  as 
now  provided  by  law  in  case  of  appeal  from  the  decisions  of  the 
county  commissioners  (ib.,  s.  6). 

Fee. — To  the  superintendent  of  the  State  board  of  health, 
for  a  license,  $5  {ib.,  s.  5). 

Tennessee. 

QUAUPICATION. — No  person  can  lawfully  practise  medicine 
in  any  of  its  departments,  except  dentistry,  unless  he  possesses 
the  qualifications  required  by  the  act.  If  a  graduate  in  med- 
icine, he  must  present  his  diploma  to  the  State  board  of  med- 
ical examiners  for  verification  as  to  its  genuineness.  If  found 
genuine  and  from  a  legally  chartered  allopathic,  homoeopathic, 
or  eclectic  medical  college  in  good  standing  with  the  school  of 
medicine  in  which  said  college  is  classed,  of  which  the  State 
board  of  medical  examiners  shall  be  the  judge,  and  the  person 
named  therein  be  the  person  claiming  and  presenting  it,  the 
board  must  issue  a  certificate  to  that  effect,  conclusive  as  to  the 
rights  of  the  lawful  holder  to  practise  medicine  (Act  of  1889,  c. 
178,  s.  1). 

^Persons  in  actual  practice  at  the  time  of  the  passage  of  the 
act  were  allowed  till  July  1st,  1891,  to  comply  with  the  pro- 
visions of  the  act  respecting  them  (ib.,  s.  2,  as  amended  Act 
1891,  c.  109,  s.  1). 

A  person  wishing  to  enter  upon  the  practice  of  medicine 
must  present  to  the  board  of  medical  examiners  a  diploma  from 
some  medical  college  in  good  standing  as  provided  by  sec.  1,  or 
shall  present  himself  to  the  said  board  for  examination  upon 
anatomy,  physiology,  chemistry,  pathology,  surgery,  obstetrics, 
and  therapeutics.  If  the  diploma  be  found  genuine,  or  if  the 
applicant  for  examination  be  found  worthy  and  competent,  the 
board  shall  issue  a  certificate  which  shall  entitle  the  lawful 
holder  to  all  the  privileges  of  this  act  {ib.,  s.  3,  as  amended 
Act  1891,  c.  109,  s.  2). 


20G  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

The  governor  appoints  six  graduate  physicians  as  a  State 
board  of  medical  examiners ;  the  three  schools  allopathic,  homoe- 
opathic, and  eclectic  must  be  represented  on  the  board ;  five  con- 
stitute a  quorum  and  a  majority  of  those  present  are  necessary 
to  reject  an  applicant,  but  such  rejection  shall  not  bar  a  re- 
examination after  the  lapse  of  three  months;  provided  the  mem- 
bers representing  each  school  shall  have  the  right  to  examine 
all  applicants  of  that  school,  and  the  board  shall  issue  the  cer- 
tificate to  applicants  who  are  recommended  by  the  member  or 
members  of  the  board  who  belong  to  said  school  after  such 
examination  (i7).,  s.  4). 

To  prevent  delay  and  inconvenience  two  members  of  the 
board  may  grant  a  temporary  license  to  any  applicant  if  the 
applicant  has  not  been  refused  a  license  by  the  board  within 
six  months,  which  shall  be  in  force  till  the  next  regular  meeting 
of  the  board  {ib.,  s.  5). 

The  members  of  the  board  shall  not  be  members  of  the  State 
board  of  health,  nor  any  medical  faculty  {ib.,  s.  6). 

The  regular  meeting  of  the  board  shall  be  once  in  each  year 
at  such  time  and  place  as  the  board  may  decide,  but  the  presi- 
dent of  the  board  may  call  a  special  meeting  when  demanded 
bj''  public  necessity  {ib.,  s.  7). 

Every  person  holding  a  certificate  must  have  it  recorded  in 
the  office  of  the  county  court  clerk  where  he  resides,  and  the 
date  of  record  must  be  indorsed  thereon.  Until  such  record  is 
made  the  holder  shall  not  exercise  any  of  the  rights  and  privi- 
leges conferred.  A  person  removing  to  another  county  to.  prac- 
tise shall  record  his  certificate  in  like  manner  in  the  county  to 
which  he  removes.  Practitioners  may  go  from  one  county 
to  another  on  professional  business,  without  being  required  to 
register,  if  they  have  done  so  in  the  county  in  which  they  reside 
{ib.,  s,  9). 

Itinerant  Physician  or  Vender.  ^ — It  is  unlawful  for  an 
itinerant  physician  or  vender  of  any  drug,  nostrum,  ointment, 
or  appliance  of  any  kind  intended  for  the  treatment  of  disease 
or  injury  to  sell  or  apply  the  same,  or  by  writing,  printing,  or 
other  method  to  profess  to  cure  or  treat  disease  or  deformity  by 
any  drug,  nostrum,  manipulation,  or  other  expedient. 

A  violation  of  this  section  is  punishable  with  a  fine  of 
$100   to  $400,  but  this  section   does  not  apply  to  merchants 


TENNESSEE — TEXAS.  207 

and  druggists,  and  this  act  does  not  apply  to  veterinary  sur- 
geons and  stock  doctors  {ib.,  s.  13,  as  amended  Act  1891,  c. 
109,  s.  3). 

Penalty,  Exception. — To  practise  medicine  or  surgery 
without  a  certificate  is  a  misdemeanor  punishable  with  a  fine 
of  from  $10  to  $25. 

To  file  or  attempt  to  file  as  his  own  the  diploma  or  certificate 
of  another  or  a  forged  affidavit  of  identification  is  a  felony 
punishable  same  as  forgery.  The  act  does  not  apply  to  women 
who  pursue  the  avocation  of  midwife  {ib.,  s.  1-4,  as  amended 
Act  1891,  c.  109,  s.  4). 

Fees. — To  the  county  court  clerk,  for  recording  certificate, 
the  usual  fee  {ib.,  s.  9). 

To  the  board  of  examiners,  for  issuing  a  certificate,  $1, 

To  the  board  of  examiners,  for  examination  of  non-grad- 
uate, $10. 

If  applicant  fails  to  pass  a  satisfactory  examination,  and  no 
certificate  or  license  is  issued  to  him,  $5  only  is  retained. 

For  a  certificate  of  temporarj'  license,  $1,  which  is  to  be 
credited  to  the  applicant  when  he  applies  for  a  permanent 
license  (?7>.,  s.  12,  as  amended  Act  1891,  c.  109,  s.  2). 

Texas. 

Constitutional  Provision. — The  legislature  may  pass 
laws  prescribing  the  qualifications  of  practitioners  of  medicine, 
but  no  preference  shall  ever  be  given  by  law  to  any  schools  of 
medicine  (Const.  1876,  art.  xiv.,  s.  31  in  part). 

Boards  of  Examiners. — A  board  of  medical  examiners  for 
each  judicial  district  is  appointed  by  the  judge  of  the  district 
court  (R.  S.,  art.  3,025). 

Each  board  is  composed  of  not  less  than  three  practising 
physicians  of  known  ability,  graduates  of  some  medical  college 
recognized  by  the  American  Medical  Association,  residents  of 
the  district  from  which  they  are  appointed  {ib.,  art.  3,026). 

The  boards  are  required  to  meet  regularly  semi-annually  at 
some  central  point  in  their  districts  to  conduct  examinations 
and  grant  certificates,  and  after  at  least  one  month's  public 
notice  of  the  time  and  place  of  meeting  by  publication  in  at 
least  one  newspaper  published  in  the  district  {ib.,  art.  3,629). 


208  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

Qualification. — The  board  is  required  to  examine  thor- 
oughl}'  all  applicants  for  a  certificate  of  qualification  to  practise 
medicine  in  any  of  its  branches  or  departments,  whether  fur- 
nished with  medical  diplomas  or  not,  upon  anatomy,  physi- 
ology, pathological  anatomy  and  pathology,  surgery,  obstetrics, 
and  chemistry ;  but  no  preference  shall  be  given  to  any  school 
of  medicine  (ib.,  art.  3,632). 

When  the  board  is  satisfied  as  to  the  qualifications  of  an 
applicant,  they  are  required  to  grant  a  certificate,  which  en- 
titles him  to  practise  medicine  in  any  county  when  it  has  been 
recorded  (ib.,  art.  3,633). 

Any  two  members  of  the  board  may  grant  a  certificate,  and 
any  member  may  grant  a  temporary  certificate  upon  examina- 
tion, which  shall  be  in  force  until  the  next  regular  meeting  of 
the  board  (ib.,  art.  3,634). 

The  certificate  must,  before  the  person  to  whom  it  was 
granted  is  entitled  to  practise,  be  recorded  in  the  office  of  the 
clerk  of  the  district  court  of  the  county  in  which  such  prac- 
titioner resides  or  sojourns,  and  when  recorded  the  clerk 
shall  certify  thereon  under  his  official  seal  the  fact  and  date  of 
record,  and  shall  return  the  certificate  to  its  owner  {ib.,  art. 
3,635). 

Exceptions. — This  title  does  not  apply  to  those  who  have 
already  qualified  under  the  act  of  May  16th,  187^,  nor  to  those 
regularly  engaged  in  the  general  practice  of  medicine  in  the 
State  in  any  branch  or  department  for  five  consecutive  years 
prior  to  January  1st,  1875,  nor  to  females  who  follow  the 
practice  of  midwifery  strictly  as  such  {ib.,  art.  3,637). 

Penalty. — No  person  except  those  named  in  art.  3,637  can 
lawfully  practise  medicine  in  any  of  its  branches  or  departments 
without  having  first  obtained  and  recorded  a  certificate  of  quali- 
fication as  above  provided.  A  person  so  offending  shall  be 
punished  as  provided  in  the  Penal  Code  {ib.,  art.  3,638). 

If  any  person  shall  practise  for  pay  or  as  a  regular  practi- 
tioner medicine  in  any  of  its  branches  or  departments,  or  offer 
or  attempt  to  practise  medicine  without  first  having  obtained  a 
certificate  of  professional  qualification  from  some  authorized 
board  of  medical  examiners,  or  without  having  a  diploma  from 
some  actual  medical  college  chartered  by  the  legislature  of  the 
State,  or  its  authority,  in  which  the  same  is  situated,  he  shall 


TEXAS — UTAH.  209 

be  punished  by  a  fine  of  not  less  than  $50,  nor  more  than  $500 
(Penal  Code,  art.  30(!). 

Each  patient  visited  or  prescribed  for,  or  each  day's  offer  to 
practise  constitutes  a  separate  offence  {ib.,  art.  397). 

If  any  person  shall  engage  in  the  practice  of  medicine  in  any 
of  its  branches  or  departments  for  pay  or  as  a  registered  practi- 
tioner, without  having  first  filed  for  record,  with  the  clerk  of  the 
district  court  of  the  county  in  which  he  resides  or  sojourns,  a 
certificate  from  some  authorized  board  of  medical  examiners  or 
a  diploma  from  some  actual  medical  college,  he  shall  be  pun- 
ished as  prescribed  in  art.  390  (ib.,  art.  398). 

Fees. — To  the  clerk  of  the  district  court,  for  recording 
certificate,  $1  (R.  S.,  art.  3,035). 

To  the  board  of  examiners,  for  examination,  $15,  whether 
certificate  is  granted  or  not  (R.  S.,  art.  3,636). 

Utah. 

Board  of  Examiners. — The  governor  appoints  by  and 
with  the  advice  and  consent  of  the  council  a  board  of  seven 
medical  examiners  from  the  various  recognized  schools  of 
medicine ;  appointees  are  required  to  be  graduates  of  a  legally 
chartered  medical  college  in  good  standing  (Act  1892,  c.  72, 
s.  1). 

Qualification. — The  board  has  power  to  issue  certificates 
to  all  who  furnish  satisfactory  proof  of  having  received  degrees 
or  licenses  from  a  chartered  medical  college  in  good  and 
legal  standing,  and  pass  examinations  before  said  board  (ib., 
s.  2). 

Graduates  of  respectable  medical  colleges  at  the  time  of  the 
passage  of  the  act  engaged  in  actual  practice  in  the  Territory 
shall  be  licensed  on  presenting  their  degree  to  the  board,  and 
producing  satisfactory  evidence  of  identit)^  (i6.,  s.  4). 

Every  person  holding  a  certificate  from  said  board  must 

have  it  recorded  in  the  office  of  the  recorder  of  the  county  in 

which  he  resides  within  three  months  from  its  date,  and  the 

date  of  record  must  be  indorsed  thereon.     Until  the  certificate 

is  recorded,  the  holder  shall  not  exercise  any  of  the  privileges 

conferred.     A  person  removing  to  another  county  to  practise 

must  record  his  certificate  in  like  manner  in  the  county  to 

which  he  removes  {ib.,  s.  5). 
u 


210  SYNOPSIS   OF  LAWS — POSTE   AND    BOSTON. 

Examinations  shall  be  wholly  or  partly  in  writing  {ib.,  s.  7). 

The  board  may  refuse  to  issue  certificates  to  individuals 
guilty  of  unprofessional  or  dishonorable  conduct,  the  nature  of 
which  shall  be  stated  in  writing,  and  it  may  revoke  certificates 
for  like  causes  to  be  stated  in  writing  {ib.,  s.  8). 

Definition. — Any  person  is  regarded  as  practising  medicine 
who  treats,  operates  upon,  or  prescribes  for  any  physical  ailment 
of  another  for  a  fee,  or  who  holds  himself  out  by  means  of  signs, 
cards,  advertisements,  or  otherwise  ns  a  phj^sician  or  surgeon. 

Exceptions. — The  act  does  not  prohibit  service  in  case  of 
emergency  or  the  administration  of  family  remedies,  and  does 
not  apply  to  commissioned  surgeons  of  the  United  States  army 
in  discharge  of  their  official  duties,  or  to  visiting  physicians  in 
actual  consultation  {ib.,  s.  9). 

Offence. — Practising  medicine  or  surgery  without  a  cer- 
tificate or  contrary  to  this  act  is  a  misdemeanor  {ib.,  s.  10). 

Persons  not  graduates  who  had  practised  continuously  for 
ten  years  in  the  Territory  prior  to  the  taking  effect  of  the  act 
were  allowed  six  months  in  which  to  comply  with  its  provisions 
concerning  them.  Practising  without  complying  with  these 
provisions,  and  practising  after  rejection  of  an  application  or 
the  revocation  of  certificate,  is  a  violation  of  the  law  {ib.,  s.  11). 

Obstetricians. — Persons  practising  obstetrics  were  re- 
quired within  three  months  after  the  passage  of  the  act  to  apply 
to  the  board  for  a  certificate,  and  after  passing  a  proper  exami- 
nation were  entitled  to  one. 

Practising  obstetrics  without  first  obtaining  a  license  or 
contrary  to  this  act  is  a  misdemeanor ;  provided  all  persons  who 
furnish  to  said  board  satisfactory  evidence  by  affidavit  or  other- 
wise of  having  practised  obstetrics  previous  to  the  passage  of 
the  act,  shall  receive  a  license  without  an  examination.  This 
section  does  not  apply  to  phj'sicians  holding  certificates  nor 
prohibit  services  in  cases  of  emergency,  nor  apply  to  persons 
practising  obstetrics  in  communities  where  there  are  no  licensed 
practitioners  {ib.,  s.  12). 

Board  Meetings. — The  board  is  required  to  meet  at  the 
territorial  capital  on  the  first  Monday  of  Januarj^,  March,  June, 
and  September  of  each  year  at  10  a.m.,  and  such  other  times 
as  the  president  of  the  board  shall  deem  necessary  {ib.,  s.  13). 

Colleges. — "Respectable  medical  colleges"    include    col- 


UTAH — VERMONT.  211 

leges  in  legal  standing  of  any  recognized  school  of  medicine 
(//>.,  s.  15). 

Fees. — To  the  treasurer  of  the  board  of  examiners,  for  ex- 
amination and  certificate,  $25  (z7>.,  s.  3). 

To  the  treasurer  of  the  board  of  examiners,  for  license  to  a 
graduate,  $5  {ib.,  s.  4). 

The  secretary  of  the  board  is  required  to  enter  without  fee, 
on  the  register  to  be  kept  by  him,  the  names  of  all  persons  to 
whom  licenses  are  issued  as  physicians  and  surgeons  {ib. ,  s.  4) . 

To  the  county  recorder,  for  recording,  his  usual  fees  (ib., 
s.  5). 

To  the  treasurer  of  the  board  of  examiners,  upon  examina- 
tion for  license  to  practise  obstetrics,  $10. 

To  the  treasurer  of  the  board  of  examiners,  upon  license  to 
practise  obstetrics  without  examination,  $1  {ib.,  s.  12). 

Vermont. 

Qualification. — The  medical  societies  organized  under  a 
charter  from  the  General  Assembly  at  each  annual  session 
elect  a  board  of  censors  of  three  members,  who  may  examine 
and  license  practitioners  of  medicine,  surgery,  and  midwifery 
(Revised  Laws,  1880,  s.  3,908). 

A  practitioner  of  medicine,  surgery,  or  midwifery  who  by 
sign  or  advertisement  offers  his  services  to  the  public  as  a  prac- 
titioner of  medicine,  surgery,  or  midwifery,  or  who  by  such 
sign  or  advertisement  assumes  the  title  of  doctor,  shall  obtain  a 
certificate  from  one  of  such  medical  societies,  either  from  a 
county,  district,  or  State  society  {ib.,  s.  3,909). 

A  person  not  a  resident  of  the  State  who  has  not  received  a 
diploma  from  a  chartered  medical  college  must  obtain  a  certifi- 
cate from  a  board  of  censors  before  he  shall  be  permitted  to 
practise  the  medical  art  in  the  State  {ib.,  s.  3,910). 

Each  board  of  censors  must  issue  certificates  without  fee  to 
physicians  and  surgeons  who  furnish  evidence  by  diploma  from 
a  medical  college  or  university,  or  bj'  a  certificate  of  examina- 
tion by  an  authorized  board,  which  satisfies  said  censors  that 
the  person  presenting  such  credentials  has  been,  after  due  ex- 
amination, deemed  qualified  to  practise  the  branch  mentioned 
in  such  diploma  or  certificate  {ib.,  s.  3,911). 


212  SYNOPSIS  OF   LAWS — POSTE   AND   BOSTON. 

The  censors  in  their  discretion  shall  notify  the  practitioner 
of  medicine,  surgerj^,  or  midwifery  of  this  chapter,  and  require 
such  persons  to  comply  therewith  within  thirty  days  after  noti- 
fication or  such  further  time  as  is  allowed  by  the  censors  not 
exceeding  ninetj^  days  [ib.,  s.  3,912). 

The  certificate  must  set  forth  the  branches  of  the  medical 
art  in  which  the  person  is  qualified  to  practise  (I'fo.,  s.  3,913). 

The  certificate  must  be  recorded  in  the  clerk's  office  of  the 
county  in  which  the  holder  resides,  or,  if  not  a  resident  of  the 
State,  in  the  county  in  which  he  obtained  his  certificate  {ib.^ 
s.  3,914). 

A  certificate  issued  by  a  board  of  censors  is  valid  through- 
out the  State  after  being  duly  recorded.  The  censors  may 
revoke  or  annul  a  certificate  if  in  their  judgment  the  holder  has 
obtained  it  fraudulently  or  has  forfeited  his  right  to  public  con- 
fidence by  the  conviction  of  crime  (^7>,  s.  3,915). 

Penalty, — To  practise  medicine,  surgery,  or  midwifery  in 
the  State,  or  sign  a  certificate  of  death  for  burial  or  removal 
unless  authorized  by  a  certificate  issued  and  recorded,  is  pun- 
ishable with  a  fine  of  from  $50  to  $200  for  the  first  offence,  and 
for  subsequent  offences  with  a  fine  of  from  $200  to  $500,  re- 
coverable by  an  action  of  debt  for  the  use  of  any  person  who 
sues  or  by  indictment  («'&.,  s.  3,916). 

No  person  practising  either  of  the  branches  of  medicine, 
surgery,  or  midwifery  is  permitted  to  enforce  in  the  courts  the 
collection  of  a  fee  or  compensation  for  services  rendered  or 
medicine  or  material  furnished  in  the  practice  of  any  of  the 
branches  for  which  he  has  not  a  certificate  {ib.,  s.  3,917). 

Exceptions. — The  law  does  not  apply  to  the  practice  of 
dentistry,  nor  to  the  practice  of  midwifery  by  women  in  the 
town  or  locality  in  which  they  reside,  nor  to  practitioners  of 
medicine  who  resided  and  practised  medicine  in  the  State  for 
five  years  previous  to  November  28th,  1876  {ib.,  s.  3,918). 

Virginia. 

Board  of  Examiners. — There  is  a  State  board  of  medical 
examiners  consisting  of  three  members  from  each  congressional 
district  and  two  from  the  State  at  large,  and  five  homoeopathic 
physicians  from  the  State  at  large  (Code  1887,  s.  1,744). 


VERMONT — VIRGINIA.  213 

The  board  is  composed  of  men  learned  in  medicine  and  sur- 
gery appointed  by  the  governor  from  a  list  of  names  recom- 
mended by  the  Medical  Society  of  Virginia,  together  with  five 
homoeopathic  physicians  nominated  to  him  by  the  Hahnemann 
Medical  Society  of  the  Old  Dominion.  The  recommendations 
are  required  to  be  by  votes  of  a  majority  present  at  some  meet- 
ing of  such  society ;  but  if  the  governor  considers  any  person 
so  recommended  unsuitable  he  may  decline  to  appoint  him,  in 
which  case  such  society  shall  within  ninety  days  after  notifica- 
tion make  another  recommendation,  and  if  the  society  fail  to 
make  a  recommendation  the  governor  is  required  to  appoint 
such  board  in  whole  or  in  part  without  regard  to  such  recom- 
mendation. If  any  examiner  cease  to  reside  in  the  district  for 
which  he  was  appointed  his  office  is  deemed  vacant  {ih.,  s. 
1,745). 

The  regular  meetings  of  the  board  are  required  to  be  held  at 
least  once  a  year,  and  at  such  times  and  places  as  the  board 
may  prescribe,  and  special  meetings  may  be  held  on  the  call  of 
the  president  and  any  five  members  (^7).,  s.  1,746). 

Qualification. — The  board  at  any  of  its  meetings  must 
examine  all  persons  making  application  to  them  who  desire  to 
practise  medicine  or  surgery ;  when  an  applicant  shall  have 
passed  an  examination  satisfactory  as  to  proficiency  before  the 
board  in  session  the  president  must  grant  a  certificate  to  that 
effect.  If  any  applicant  fail  to  pass  a  satisfactory  examination 
before  the  board  he  shall  not  be  permitted  to  stand  a  further 
examination  within  the  next  three  months,  nor  shall  he  be  re- 
quired again  to  pay  the  fees  prescribed,  but  no  applicant  shall 
be  rejected  on  his  examination  on  account  of  his  adherence 
to  any  particular  school  of  medicine  or  system  of  practice,  nor 
on  account  of  his  views  as  to  the  method  of  treatment  and  the 
cure  of  disease. 

When,  in  the  opinion  of  the  president  of  the  board,  the 
applicant  has  been  prevented  by  good  cause  from  appearing 
before  the  board,  he  shall  appoint  a  committee  of  three  mem- 
bers who  shall  examine  the  applicant  and  may  grant  a  certifi- 
cate having  the  same  effect  as  though  granted  bj^  a  full  board, 
until  the  applicant  have  an  opportunity  to  appear  before  the 
board,  when,  if  he  fail  to  appear  for  examination,  the  president 
shall  have  the  authority  to  revoke  said  certificate;  or  in  any 


214  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

case  the  president  shall  have  authority,  at  his  discretion,  to 
grant  a  special  permit  to  any  applicant  to  practise  medicine 
until  he  shall  have  an  opportunity  to  appear  before  the  board  in 
session  for  examination,  revokable  at  the  discretion  of  the  pres- 
ident. The  board  has  in  its  discretion  authority  to  accept  in 
lieu  of  examination  a  certificate  from  a  medical  board  of  any 
other  State,  showing  that  the  applicant  has  passed  a  satisfac- 
tory examination  as  to  his  proficienc}',  and  obtained  a  license 
from  said  board  to  practise  medicine  and  surgery  in  said  State 
(lb.,  s.  1,747,  as  amended  Act  1892,  c.  70). 

A  person  obtaining  a  certificate  from  the  president  of  the 
board  must  cause  it  to  be  recorded  in  the  clerk's  office  of  the 
county  or  the  corporation  court,  of  the  count}^  or  corporation 
in  which  he  resides,  or,  if  he  resides  in  the  city  of  Richmond, 
in  the  clerk's  office  of  the  chancery  court  of  the  said  city  (?6. , 
s.  1,749). 

No  person  who  shall  have  commenced  the  practice  of  medi- 
cine or  surgery  since  January  1st,  1885,  or  who  shall  hereafter 
commence  the  practice  of  the  same,  shall  practise  as  a  physician 
or  surgeon  for  compensation  without  having  obtained  a  certifi- 
cate and  caused  it  to  be  recorded. 

Penalty. — The  violation  of  this  act  is  punishable  with  a 
fine  of  from  $50  to  $500  for  each  ofi^ence,  and  the  violator  is 
debarred  from  receiving  compensation  for  services  rendered  as 
a  physician  or  surgeon ;  a  person  assessed  with  a  license  tax  as 
a  physician  or  surgeon  by  any  commissiouer  of  revenue  prior  to 
July  1st,  1892,  shall  be  taken  as  having  commenced  the  prac- 
tice of  medicine  or  surgery  prior  to  that  date;  but  an}-  person 
who  shall  not  have  been  so  assessed  shall  be  taken  as  not  hav- 
ing commenced  such  practice  prior  to  that  date  {ib.,  s.  1,750, 
as  amended  Act  1892,  c.  70). 

Non-Residents. — A  physician  or  surgeon  residing  in  an 
adjoining  State  within  ten  miles  of  the  boundary  line  of  this 
State,  is  entitled  to  stand  the  examination  and  receive  a  cer- 
tificate, and  the  certificate  must  be  recorded  in  that  county  in 
the  State  nearest  to  his  place  of  residence,  and  such  certificate 
and  recordation  shall  make  it  lawful  for  him  to  practise  med- 
icine and  surgery  in  this  State  (ib.,  s.  1,751). 

Exceptions. — This  chapter  does  not  affect  practitioners  of 
dentistry,  nor  include  physicians  or  surgeons  residing  in  other 


VIRGINIA — WASHINGTON.  215 

States  called  into  consultation  in  a  special  case  with  a  physician 
or  surgeon  residing  in  this  State,  nor  does  it  affect  in  any 
way  the  laws  in  reference-to  the  license  tax  {ib.,  s.  1,752)  nor 
does  it  apply  to  midwives  (ib.,  s.  1,753). 

Fees. — To  the  board  of  examiners,  before  examination,  $5 
{ib.,  s.  1,747,  as  amended  Act  1892,  c.  70). 

To  the  clerk  of  the  court,  for  recording,  same  fee  as  for  re- 
cording a  deed  {ib.,  s.  1,749). 

Washington. 

Examining  Board. — The  governor  is  required  to  appoint 
a  State  medical  examining  board  of  nine  members,  learned  and 
skilled  in  the  practice  and  theory  of  medicine  and  surgery  (Act 
March  28th,  1890,  s.  1). 

The  said  board  is  required  to  hold  meetings  for  examination 
on  the  first  Tuesday  of  January  and  July  in  each  year,  alter- 
nately in  western  and  eastern  Washington  at  such  places  as 
the  board  may  designate.  The  board  may  call  special  meetings 
when,  in  the  opinion  of  a  majority  of  the  board,  they  are  nec- 
essary. The  board  is  required  to  keep  a  record  of  all  applicants 
for  a  license,  with  their  ages,  the  time  spent  in  the  study  and 
practice  of  medicine  and  surgery,  and  the  name  and  location  of 
all  institutions  granting  to  such  applicants  degrees  or  certifi- 
cates of  lectures  in  medicine  or  surgery,  and  whether  such 
applicant  was  rejected  or  licensed;  and  said  register  is prz'wia 
facie  evidence  of  all  matters  therein  recorded  {ib.,  s.  2). 

Qualification. — Every  person  desiring  to  commence  the 
practice  of  medicine  or  surgery,  or  either  of  them,  in  any  of 
their  or  its  branches,  must  make  a  written  application  to  the 
board  for  a  license,  supported  by  an  affidavit  of  the  applicant, 
setting  forth  the  actual  time  spent  in  the  study  of  medicine 
and  surgery,  and  when ;  whether  such  study  was  in  an  institu- 
tion of  learning  and,  if  so,  its  name  and  location ;  if  not  in  such 
institution,  where  and  under  whose  tutorship  such  study  was 
prosecuted,  the  time  engaged  in  the  actual  practice,  if  at  all, 
of  medicine  and  surgery  or  either,  and  where,  and  the  age  of 
the  applicant  at  the  time  of  the  application,  such  application 
and  affidavit  to  be  filed  and  preserved  of  record  in  the  office 
of  the  secretary  of  the  board.     At  the  time  and  place  designated 


216  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

by  the  board  or  at  a  regular  meeting  of  the  board,  applicants 
must  be  examined  in  anatomy,  physiology,  chemistry,  histology, 
materia  medica,  therapeutics,  preventive  medicines,  the  practice 
of  medicine,  surgery,  obstetrics,  diseases  of  women  and  children, 
of  the  nervous  system,  of  the  eye  and  ear,  medical  jurisprudence, 
and  such  other  branches  as  the  board  deem  advisable.  The  ex- 
amination must  be  both  scientific  and  practical,  and  of  suflficient 
severity  to  test  the  candidate's  fitness  to  practise  medicine  and 
surgery,  by  written  or  printed,  or  partly  written  and  partly 
printed,  questions  and  answers,  and  the  same  are  required  to  be 
filed  and  preserved  of  record  in  the  said  secretary's  office. 
After  the  examination,  if  it  be  satisfactory,  the  board  shall 
grant  a  license,  by  the  consent  of  not  less  than  five  members, 
except  as  hereinafter  provided. 

Refusal  or  Revocation. — The  board  may  refuse  or  re- 
voke a  license  for  unprofessional  or  dishonorable  conduct,  sub- 
ject to  the  right  of  appeal  {ib.,  s.  3). 

"  Unprofessional  or  dishonorable  conduct"  means :  procuring 
or  aiding  or  abetting  in  procuring  a  criminal  abortion ;  or  em- 
ploying what  are  popularly  known  as  cappers  or  steerers;  or 
obtaining  any  fee  on  the  assurance  that  a  manifestly  incurable 
disease  can  be  permanently  cured;  or  wilfully  betraying  a 
professional  secret;  or  advertisements  of  medical  business  in 
which  untruthful  and  improbable  statements  are  made;  or  ad- 
vertising any  medicine  or  means  whereby  the  monthly  periods 
of  women  can  be  regulated,  or  the  menses  re-established  if  sup- 
pressed; or  the  conviction  of  any  offence  involving  moral  turpi- 
tude; or  habitual  intemperance  {ib.,  s.  4). 

In  case  of  a  refusal  or  a  revocation  of  a  license,  the  board  is 
required  to  file  a  brief  and  concise  statement  of  the  grounds  and 
reasons  thereof  in  the  office  of  its  secretarj^,  which,  with  the 
decision  of  the  board  in  writing,  shall  remain  of  record  in  said 
office.  Before  a  license  can  be  revoked  for  unprofessional  or 
dishonorable  conduct,  a  complaint  of  some  person  under  oath 
must  be  filed  in  the  office  of  the  secretary  of  the  board,  charging 
the  acts  of  unprofessional  or  dishonorable  conduct  and  the  facts 
complained  against  the  accused  in  ordinary  and  concise  lan- 
guage, and  at  least  ten  days  prior  to  the  hearing  the  board  shall 
cause  to  be  served  upon  the  accused  a  written  notice  and  a  copy 
of  such  complaint  containing  a  statement  of  the  time  and  place 


WASHINGTON.  217 

of  the  hearing.  The  accused  ma}^  appear  at  the  hearing  and  de- 
fend in  person  or  by  counsel,  and  may  have  the  sworn  testimony 
of  witnesses  taken  and  present  other  evidence  in  his  behalf,  and 
the  board  may  receive  arguments  of  counsel  {ib.,  s.  5). 

In  case  of  refusal  or  revocation  of  a  license  by  the  board, 
there  is  a  right  of  appeal  within  thirty  days  after  the 
filing  of  the  decree  in  the  office  of  the  secretary,  to  the  superior 
court  in  and  for  the  county  in  which  was  held  the  last  general 
meeting  of  the  board  prior  to  the  refusal  of  the  license,  in  case 
of  refusal;  and  to  the  superior  court  in  and  for  the  county  in 
which  the  hearing  was  had  upon  which  such  license  was  re- 
voked, in  case  of  revocation.  The  person  desiring  to  appeal 
must  serve  or  cause  to  be  served  on  the  said  secretary  a  written 
notice  of  appeal  containing  a  statement  of  its  grounds,  and 
must  file  in  the  said  secretary's  office  an  appeal  bond  with  a 
good  and  sufficient  surety  to  be  approved  by  the  Secretarj^  of 
the  State  of  Washington,  conditioned  for  the  speedy  prosecution 
of  such  appeal  and  the  payment  of  such  costs  as  may  be  adjudi- 
cated against  him  upon  such  appeal.  Said  secretary  must 
within  ten  days  after  service  of  said  notice  and  filing,  and  the 
approval  of  the  said  appeal  bond,  transmit  to  the  clerk  of  the 
court  to  which  the  appeal  is  taken  a  certified  cop}-,  under  the 
seal  of  the  board,  of  the  decision  and  the  grounds,  in  case  of 
refusal,  and  in  addition  a  certified  copy  under  said  seal  of  the 
complaint,  in  the  case  of  revocation,  with  the  bond  and  notice  of 
appeal.  The  clerk  must  thereupon  docket  such  appeal  causes 
and  they  stand  for  trial  in  all  respects  as  ordinary  civil 
actions,  and  like  proceedings  are  had  thereon.  On  appeal  the 
cause  is  tried  de  novo.  Either  party  may  appeal  from  a 
judgment  of  the  superior  court  to  the  supreme  court  in  like 
manner  as  in  civil  actions  within  sixt}^  days  after  the  rendition 
and  entry  of  such  judgment.  If  the  judgment  be  in  favor  of 
the  party  appealing  from  the  decision  of  the  board,  and  the 
examining  board  does  not  appeal  within  sixty  days,  in  that 
case  at  the  end  of  sixty  daj^s  the  board  shall  immediatel}'  issue 
to  the  successful  party  the  usual  license,  and  in  addition  rein- 
state upon  its  records  the  name  of  such  successful  applicant, 
in  case  of  revocation.  In  case  of  appeal  to  the  supreme  court 
by  the  board,  no  such  license  shall  be  issued  nor  reinstatement 
required  until  the  final  determination  of  the  cause.     In  case 


218  SYNOPSIS   OF   LAWS— POSTE   AND   BOSTON. 

the  final  decision  of  the  supreme  court  be  against  the  board, 
then  the  said  court  shall  make  such  order  as  may  be  necessary 
and  the  board  shall  act  accordingly.  No  appeal  bond  can  be 
required  of  the  board,  nor  any  costs  adjudged  or  taxed  against 
the  same  {ib.,  s.  6). 

Filing  Authority. — The  person  receiving  a  license  must 
file  it,  or  a  copy,  with  the  county  clerk  of  the  county  where  he 
resides,  and  the  county  clerk  is  required  to  file  said  certificate 
or  copy  and  enter  a  memorandum  thereof,  giving  its  date  and 
the  name  of  the  person  to  whom  it  was  issued,  and  the  date  of 
filing,  and  on  notice  to  him  of  a  change  of  location  or  the  death 
of  a  person  licensed  or  of  revocation,  the  county  clerk  is  required 
to  enter  a  memorandum  of  said  fact  at  the  appropriate  place  in 
the  record.  In  case  of  removal  into  another  county,  the  person 
licensed  must  procure  from  the  county  clerk  a  certified  copy  of 
the  said  license,  and  file  it  with  the  county  clerk  of  the  county  to 
which  he  shall  remove,  with  like  effect  as  an  original  license 
{ib.,  s.  7). 

Penalty,  Definition. — To  practise  medicine  or  surgery 
without  a  license  or  contrary  to  this  chapter  is  a  misdemeanor 
punishable  with  a  fine  of  from  $50  to  $100,  or  imprisonment  in 
a  county  jail  from  ten  to  ninety  days,  or  both.  Any  person  is 
regarded  as  practising  who  appends  the  letters  ''M.D."  or 
"M.B."  to  his  name,  or  for  a  fee  prescribes,  directs,  or  recom- 
mends for  the  use  of  any  person  any  drug  or  medicine  or  agency 
for  the  treatment,  care,  or  relief  of  anj^  wound,  fracture,  or 
bodily  injury,  infirmity,  or  disease ;  but  the  chapter  does  not 
apply  to  dentists. 

Regulations. — The  board  has  authority  to  prescribe  and 
establish  all  needful  rules  and  regulations  to  carry  this  chapter 
into  effect  {ib.,  s.  9). 

Former  Practitioner. — All  persons  licensed  under  sec. 
2,289  of  the  laws  of  Washington  Territory,  1881,  or  having 
complied  with  its  provisions,  are  to  be  taken  and  considered  as 
licensed  under  this  act,  and  the  secretary  of  the  board  is  re- 
quired to  enter  the  names  of  such  persons  upon  the  register  kept 
by  him,  as  licensed  physicians  and  surgeons  on  their  written  ap- 
plication {ib.,  s.  10). 

Fee. — To  the  treasurer  of  the  board,  for  examination, 
{ib.,  s.  3). 


WEST   VIRGINIA.  219 


West  Virginia. 

Qualification. — The  following  persons  and  no  others  are 
permitted  to  practise  medicine : 

1.  Graduates  of  a  reputable  medical  college  in  the  school  of 
medicine  to  which  the  person  desiring  to  practise  belongs. 
Such  person  must  present  his  diploma  to  the  State  board  of 
health,  or  the  two  members  thereof  in  his  congressional  district, 
and  if  it  be  found  to  be  genuine  and  was  issued  by  such  med- 
ical college  as  hereinafter  mentioned,  and  the  person  presenting 
it  be  the  graduate  therein  named,  the  board  or  said  two  mem- 
bers, as  the  case  may  be,  must  issue  and  deliver  to  him  a  cer- 
tificate to  that  effect,  and  such  diploma  and  certificate  shall 
entitle  the  person  named  in  the  diploma  to  practise  medicine  in 
all  its  departments. 

2.  Persons  not  graduates  in  medicine  who  had  practised 
medicine  in  this  State  under  a  certificate  issued  by  the  State 
board  of  health  prior  to  the  passage  of  the  act  are  authorized  to 
practise  medicine  in  all  its  departments. 

3.  A  person  not  a  graduate  of  medicine  and  who  has  not 
practised  medicine  in  this  State  under  a  certificate  must  be 
examined  by  the  State  board  of  health,  or  the  two  members 
thereof  in  the  congressional  district  where  he  resides,  or  if  he 
resides  out  of  the  State  by  the  two  members  in  the  congressional 
district  nearest  to  his  place  of  residence,  who,  together  with  a 
member  of  the  local  board  of  health  who  is  a  physician,  if 
there  be  such  a  member  of  the  local  board  of  health  of  the 
county  in  which  the  examination  is  held,  shall  examine  him ; 
and  if  upon  a  full  examination  they  find  him  qualified  to  prac- 
tise medicine  in  all  its  departments,  they,  or  a  majority  of  them, 
shall  grant  him  a  certificate  to  that  effect,  and  thereafter  he 
shall  have  the  right  to  practise  medicine  in  the  State  to  the 
same  extent  as  if  he  had  the  diploma  and  certificate  above 
mentioned.  The  members  of  the  State  board  of  health  in  each 
congressional  district  must,  by  publication  in  some  newspaper 
printed  in  the  county  in  which  their  meeting  is  to  be  held,  or 
if  no  such  paper  is  printed  therein,  in  some  newspaper  of  gen- 
eral circulation  in  such  district,  give  at  least  twenty-one  days' 
notice  of  the  time  and  place  of  their  meeting  for  the  examina- 


220  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

tion  of  applicants  for  permission  to  practise  medicine,  published 
at  least  once  a  week  for  three  consecutive  weeks  before  the  day 
of  such  meeting. 

This  section  does  not  apply  to  a  physician  or  surgeon  called 
from  another  State  to  treat  a  particular  case  or  to  perform  a 
particular  surgical  operation  in  the  State,  or  who  does  not 
otherwise  practise  in  the  State  (Code  of  W.  Va.,  1891,  c.  150, 
s.  9). 

Every  person  holding  a  certificate  must  have  it  recorded 
in  the  office  of  the  secretary  of  the  State  board  of  health,  and 
the  secretary  is  required  to  indorse  on  said  certificate  the  fact 
of  such  recordation  and  deliver  the  same  to  the  person  named 
therein  or  his  order. 

The  State  board  of  health  may  refuse  certificates  to  indi* 
viduals  guilty  of  malpractice  or  dishonorable  conduct,  and  may 
revoke  certificates  for  like  causes ;  such  revocation  being  after 
due  notice  and  trial  by  the  said  board,  with  right  of  appeal  to 
the  circuit  court  of  the  county  in  which  such  individual  resides ; 
but  no  such  refusal  or  revocation  shall  be  made  by  reason  of  his 
belonging  to  or  practising  in  any  particular  school  or  system  of 
medicine  {ib.,  s.  10). 

The  examination  fee  is  not  retained  if  a  certificate  is  refused, 
but  the  applicant  may  again,  at  any  time  within  a  j'ear  after 
refusal,  be  examined  without  an  additional  fee,  and  if  a  cer- 
tificate be  again  refused  he  may,  as  often  as  he  sees  fit,  on 
payment  of  the  fee,  be  examined  until  he  obtains  a  certificate 
{ib.,  s.  11). 

Examinations  may  be  wholly  or  partly  in  writing,  and  shall 
be  of  an  elementary  and  practical  character,  embracing  the  gen- 
eral subjects  of  anatomy,  physiology,  chemistry,  materia 
medica,  pathology,  pathological  anatomj^  surgery,  and  obstet- 
rics, but  sufficientl}^  strict  to  test  the  qualificatioas  of  the  can- 
didate as  a  practitioner  of  medicine,  surgerj",  and  obstetrics. 
The  chapter  does  not  apply  to  females  practising  midwifery 
(ib.,  s.  12). 

Definition,  Exceptions. — Any  person  is  regarded  as 
practising  medicine  who  professes  publicly  to  be  a  physician, 
and  to  prescribe  for  the  sick,  or  who  appends  to  his  name 
"M.D."  This  act  also  applies  to  apothecaries  and  pharmacists 
who  prescribe  for  the  sick.     It  does  not  apply  to  commissioned 


WEST   VIRGINIA.  221 

officers  of  the  United  States  army  and  navy  and  marine  hos- 
pital service  {ib.,  s.  13). 

Itinerant  Physician  or  Vender. — Any  itinerant  physi- 
cian or  itinerant  vender  of  any  drug,  nostrum,  ointment,  or 
aj^pliance  of  any  kind  intended  for  the  treatment  of  disease  or 
injury,  or  who  shall  by  writing  or  printing  or  in  any  other 
method  publicly  profess  to  cure  or  treat  diseases,  injuries,  or 
deformities  by  any  drug,  nostrum,  manipulation,  or  other  ex- 
pedient, shall  before  doing  so  pay  to  the  sheriff  of  every  county 
in  which  he  desires  to  practise  a  special  tax  of  $50  for  each 
month  or  fraction  of  a  month  ho  shall  so  practise  in  such 
county,  and  take  his  receipt  in  duplicate  therefor.  He  shall 
present  said  receipts  to  the  clerk  of  the  county  court  of  such 
county,  who  shall  file  and  preserve  one  of  them  in  his  office  and 
indorse  on  the  other,  "A  duplicate  of  this  receipt  has  been 
filed  in  my  office,"  and  sign  the  same.  For  such  a  person  to 
practise  or  attempt  to  practise  in  any  county  without  having 
jjaid  such  tax  and  filed  such  receipt  and  obtained  such  indorse- 
ment, or  to  practise  or  attempt  to  practise  for  a  longer  time 
than  that  for  which  he  has  paid  a  tax,  is  a  misdemeanor  pun- 
ishable with  a  fine  of  from  $100  to  $500.  Any  person  who 
shall  travel  from  place  to  place  and  by  writing,  printing,  or 
otherwise  publicly  profess  to  cure  or  treat  diseases,  injuries,  or 
deformities  is  deemed  an  itinerant  physician  subject  to  the 
taxes,  fines,  and  penalties  of  this  section  (ib.,  s.  14). 

Penalty. — To  practise  or  attempt  to  practise  medicine, 
surgery,  or  obstetrics  without  compljang  with  sec.  9  is  a  mis- 
demeanor punishable,  for  every  offence,  with  a  fine  of  from 
$50  to  $500  or  imprisonment  in  a  county  jail  from  one  month  to 
twelve  months,  or  both.  To  file  or  attempt  to  file  as  his  own  a 
diploma  or  certificate  of  another,  or  a  false  or  forged  affidavit 
of  identity,  or  wilfully  swear  falsely  to  any  question  propounded 
to  him  on  examination  or  to  any  affidavit  required  to  be  made 
and  filed,  is  punishable  with  confinement  in  the  penitentiary 
from  one  to  three  years  or  imprisonment  in  a  county  jail  from 
six  to  twelve  months,  and  a  fine  of  from  $100  to  $500  (ib., 
s.  15). 

Fee. — To  the  State  board  of  health,  or  its  examining 
members,  for  examination,  $10  (ib.,  s.  11). 


222  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 


Wisconsin. 

Prohibition. — No  person  practising  physic  or  surgery,  or 
both,  shall  have  the  right  to  collect  in  any  action  in  any  court 
fees  or  compensation  for  the  performance  of  any  medical  or 
surgical  service,  or  to  testify  in  a  professional  capacity  as  a 
physician  or  surgeon,  unless  he  shall  have  received  a  diploma 
from  some  incorporated  medical  society  or  college  or  shall  be  a 
member  of  the  State  or  some  county  medical  society  legally 
organized  in  this  State ;  provided  that  in  all  criminal  actions  the 
court  may  in  its  discretion  and  in  the  furtherance  of  justice 
receive  the  testimony  of  any  physician  or  surgeon  without  re- 
quiring proof  of  the  incorporation  of  the  medical  society  or 
college  from  which  he  graduated  (R.  S.,  1878,  s.  1,436,  as 
amended  c.  131,  1887). 

No  person  practising  physic  or  surgery,  or  both,  prohibited 
by  the  above  section  from  testifying  in  a  professional  capacity 
as  a  physician  or  surgeon,  shall  assume  the  title  of  doctor,  phy- 
sician, or  surgeon  by  means  of  any  abbreviation  or  by  the  use 
of  any  other  word  or  words,  letters  of  the  alphabet  of  the  Eng- 
lish or  any  other  language,  or  any  device  of  whatsoever  kind, 
printed,  written,  or  painted,  or  exhibited  in  any  advertisement, 
circular,  handbill,  letter,  or  other  instrument,  nor  on  any  card, 
sign,  door,  or  place  whatsoever. 

Penalty,  Exceptions. — A  violation  of  this  act  is  a  mis- 
demeanor punishable  with  a  fine  of  from  825  to  $100,  or  im- 
prisonment in  a  county  jail  from  ten  days  to  sixty  days  for 
each  offence  (s.  1,  c.  256,  1881,  as  amended  c.  40,  1882). 

On  complaint  in  writing  under  oath  before  any  magistrate 
or  justice  of  the  peace  .charging  the  commission  of  an  offence 
against  tlie  provisions  of  this  act  in  his  county,  it  is  the  duty  of 
the  district  attorney  to  prosecute  the  offender,  and  in  all  such 
prosecutions  the  burden  of  proof  shall  be  upon  the  defendant  to 
establish  his  right  to  use  such  title  under  the  provisions  of  this 
act  (ib.,  s.  2). 

Any  person  prohibited  by  sec.  1  from  assuming  the  title  of 
doctor,  physician,  or  surgeon  who  shall  practise  or  pretend  to 
practise  physic  or  surgery,  or  both,  is  not  exempted  from  any, 
but  is  liable  to  all,  of  the  legal  penalties  and  liabilities  ot  mal- 


WISCONSIN — WYOMING.  223 

practice,  and  ignorance  shall  be  no  excuse  for  a  failure  to  per- 
form or  for  neglect  or  unskilfully  performing  or  attempting  to 
perform  any  of  the  duties  required  by  law  of  practising  physi- 
cians or  surgeons.  The  act  does  not  prevent  students  from 
practising  under  the  direction  of  a  qualified  preceptor,  nor 
women  from  practising  midwifery,  nor  veterinarians  from 
practising  in  their  special  department  {ib.,  s.  3). 

Wyoming. 

Qualification. — No  person  can  lawfully  practise  medicine, 
surgery,  or  obstetrics  who  has  not  received  a  medical  education 
and  diploma  from  some  regularly  chartered  medical  school  hav- 
ing a  bona  fide  existence  when  the  diploma  was  granted  (R.  S., 
1887,  s.  1,925). 

Every  physician,  surgeon,  or  obstetrician  must  file  for 
record  with  the  register  of  deeds  of  the  county  in  which  he  is 
about  to  practise  or  where  he  practises,  a  copy  of  his  diploma, 
exhibiting  the  original,  or  a  certificate  from  the  dean  of  the 
medical  school  of  which  he  is  a  graduate  certifying  to  his  grad- 
uation {ib.,  s.  1,926). 

When  filing  a  copy  of  his  diploma  or  certificate  of  gradua- 
tion, he  must  be  identified  as  the  person  named  in  the  paper 
about  to  be  filed  by  the  affidavit  of  two  citizens  of  the  county, 
or  his  affidavit  taken  before  a  notary  public  or  commissioner  of 
deeds  for  the  State,  which  affidavit  must  be  filed  in  the  office 
of  the  register  of  deeds  {ib.,  s.  1,927). 

Penalty. — To  practise  without  complying  with  this  chapter 
is  a  misdemeanor  punishable  with  a  fine  of  from  $50  to  $500  or 
imprisonment  in  a  county  jail  from  thirty  days  to  six  months, 
or  both,  for  each  offence.  To  file  or  attempt  to  file  as  his  own 
a  diploma  or  certificate  of  another,  or  a  forged  affidavit  of  iden- 
tification, is  a  felony  subject  to  a  fine  and  imprisonment  in  the 
penitentiary  {ib.,  s.  1,928). 

It  is  the  duty  of  the  police,  sheriff,  or  constable  to  arrest  all 
persons  practising  medicine,  surgery,  or  obstetrics  without 
complying  with  these  provisions  {ib.,  s.  1,929). 

Exceptions. — This  chapter  does  not  apply  to  persons  in 
emergency  prescribing  or  giving  advice  in  medicine,  surgery, 
or  obstetrics  in  a  section  of  country  where  no  physician,  sur- 


224  SYNOPSIS   OP   LAWS — POSTE   AND    BOSTON. 

geon,  or  obstetrician  resides,  or  where  no  physician,  surgeon, 
or  obstetrician  resides  within  a  convenient  distance,  nor  to 
persons  prescribing  in  their  own  families,  nor  to  persons  claim- 
ing to  practise  medicine,  surgery,  or  obstetrics  in  any  section 
of  the  State  where  no  physician  or  surgeon  having  a  diploma 
or  a  certificate  resides  {ib.,  s.  1,930). 

Evidence. — On  the  trial  of  persons  charged  with  the  vio- 
lation of  this  chapter  it  shall  be  sufficient  for  the  prosecution 
to  show  that  defendant  has  practised  medicine,  surgery,  or  ob- 
stetrics within  the  county  where  the  indictment  is  found  at  any 
time  since  the  passage  of  the  act  (1876),  and  the  defendant 
shall  not  after  proof  be  entitled  to  acquittal  until  he  show& 
by  the  testimony  of  some  competent  witness  upon  oath  that 
the  defendant  has  received  a  medical  education,  and  a  genuine- 
diploma  from  some  regularly  chartered  medical  school ;  provided 
that  the  defendant  may  show  such  facts  by  depositions  taken  in 
the  same  manner  as  depositions  in  civil  cases  {ib.,  s.  1,931). 


The  United  Kingdom  of  Great  Britain  and  Ireland. 

Medical  Acts. — The  Act  21  and  22  Victoria,  c.  90,  and  the- 
amendments  thereof  and  additions  thereto,  are  generally  spoken 
of  as  the  Medical  Acts. 

Medical  Councils. — There  is  a  general  council  of  medical 
education  and  registration  of  the  United  Kingdom,  with  branch 
councils  for  England,  Scotland,  and  Ireland  (21  and  22  Vict., 
1858,  c.  90,  s.  3,  6). 

Members  of  the  general  council  are  chosen  as  provided  in  49 
and  50  Vict.,  c.  48,  s.  7;  those  representing  the  medical  cor- 
porations must  be  qualified  to  register  under  this  act  (21  and  22 
Vict.,  c.  90,  s.  7). 

The  general  council  appoints  a  registrar  for  England,  and 
the  branch  councils  for  Scotland  and  Ireland  appoint  respectively 
a  registrar  for  Scotland  and  Ireland  {ib.,  s.  10,  11). 

Registrar. — It  is  the  duty  of  the  registrars  to  keep  their 
registers  correct,  and  to  erase  the  names  of  all  registered  persons 
who  shall  have  died,  and  from  time  to  time  to  make  the  necessary 
alterations  in  the  addresses  or  qualifications  of  persons  registered. 
It  is  lawful  for  the  registrar  to  write  a  letter  to  any  registered 


GREAT   BRITAIN   AND   IRELAND.  225 

person,  addressed  to  him  according  to  his  address  on  the  regis- 
ter, to  inquire  whether  he  has  ceased  to  practise  or  has  changed 
his  residence,  and  if  no  answer  be  returned  within  six  months 
from  the  time  of  sending  the  letter,  it  is  lawful  to  erase  the 
name  of  such  person  from  the  register,  but  it  may  be  restored 
by  direction  of  the  general  council  {ib.,  s.  14). 

Qualification. — Persons  possessed  of  one  or  more  of  the 
qualifications  described  in  Schedule  A,  on  the  payment  of  a  fee 
not  exceeding  £5,  are  entitled  to  register  on  the  production  to 
the  registrar  of  the  branch  council  for  England,  Scotland,  or 
Ireland  the  document  conferring  or  evidencing  the  qualification 
in  respect  whereof  he  seeks  to  be  registered,  or  upon  transmitting 
by  post  to  such  registrar  information  of  his  name  and  address, 
and  evidence  of  his  qualifications  and  of  the  time  or  times  at 
which  they  were  obtained.  The  several  colleges  and  bodies  men- 
tioned in  Schedule  A  may  transmit  from  time  to  time  to  the 
registrar,  under  their  respective  seals,  lists  of  the  persons  who 
by  grant  of  such  colleges  and  bodies  respectively,  are  for  the  time 
being  entitled  to  register,  stating  the  qualifications  and  resi- 
dences of  such  persons,  and  it  shall  be  lawful  for  the  registrar  on 
the  payment  of  the  said  fee  to  enter  in  the  register  the  persons 
mentioned  in  such  lists  with  their  qualifications  and  places  of 
residences  as  therein  stated  without  other  application  {ib.,  s.  15). 

The  general  council  is  required  to  make  orders  for  regulat- 
ing the  registers  from  time  to  time  {ib.,  s.  16). 

Persons  actually  practising  medicine  in  England  before 
August  1st,  1815,  were  entitled  to  register  under  the  act  {ib., 
s.  17). 

Any  two  or  more  of  the  colleges  and  bodies  in  the  United 
Kingdom  mentioned  in  Schedule  A  may,  with  the  sanction  and 
under  the  direction  of  the  general  council,  unite  or  co-oper- 
ate in  conducting  the  examinations  required  for  qualifications 
to  be  registered  {ib.,  s.  19,  37  and  38  Vict.,  c.  34). 

The  privy  council  ma}'  suspend  the  right  of  registration  in 
respect  of  qualifications  granted  by  any  college  or  body  {ib., 
s.  21). 

After  such  revocation,  no  person  shall  be  entitled  to  register 
in  respect  to  any  qualification  granted  by  such  college  before 
revocation  {ib.,  s.  22). 

The  privy  council  may  issue  an  injunction  directing  any 

15 


22(3  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

body  entitled  to  grant  qualifications  to  desist  from  imposing 
upon  any  candidate  for  examination  an  obligation  to  adopt  or 
refrain  from  adopting  the  practice  of  any  particular  theory  of 
medicine  or  surgery  as  a  test  or  condition  of  admitting  him  to 
examination  or  granting  him  a  certificate ;  and  in  the  event  of 
their  not  complying,  may  order  that  such  body  cease  to  have  the 
power  of  conferring  a  right  to  be  registered  so  long  as  they 
shall  continue  such  practice  (ib.,  s.  23). 

Where  any  person  entitled  to  be  registered  applies  to  the 
registrar  of  any  branch  council  for  that  purpose,  such  registrar 
is  required  forthwith  to  enter  in  a  local  register  the  name  and 
place  of  residence,  and  the  qualifications  in  respect  of  which 
the  person  is  so  entitled  and  the  date  of  registration ;  and  in 
case  of  the  branch  council  for  Scotland  or  Ireland,  to  send  to 
the  registrar  of  the  general  council  a  copy  of  the  entry,  and 
the  registrar  of  the  general  council  is  required  to  cause  the 
same  to  be  entered  in  the  general  register ;  and  such  registrar 
is  required  to  cause  all  entries  made  in  the  local  register  for 
England  to  be  entered  in  the  general  register  {ib.,  s.  25). 

No  qualification  is  entered  on  the  register,  on  the  first  regis- 
tration or  by  way  of  addition  to  a  regular  name,  unless  the  reg- 
istrar be  satisfied  by  proper  evidence  that  the  person  claiming 
it  is  entitled  to  it.  Any  appeal  from  the  decision  of  the  regis- 
trar may  be  decided  by  the  general  council  or  by  the  council  for 
England,  Scotland,  or  Ireland,  as  the  case  may  be.  Any  entry 
proved  to  the  satisfaction  of  such  general  council  or  branch 
council  to  have  been  fraudulent^  or  incorrectly  made  may  be 
erased  from  the  register  b}'  an  order  in  writing  of  such  general 
council  or  branch  council  {ib.,  s.  26). 

Medical  Register. — The  registrar  of  the  general  council 
is  required  to  cause  to  be  printed,  published,  and  sold  under 
the  direction  of  such  council,  everj^  yeai'j.  a  correct  register  of 
the  names  with  the  respective  residences  and  medical  titles, 
diplomas,  and  qualifications  conferred  by  any  corporation  or 
university  or  by  a  doctorate  of  the  Archbishop  of  Canterbury, 
with  the  dates  thereof,  of  all  persons  appearing  on  the  general 
register  as  existing  on  January  1st  in  every  j^ear.  Such  register 
is  called  the  Medical  Register,  and  a  copy  of  the  Medical 
Register  for  the  time  being  is  evidence  that  the  persons  therein 
specified  are  registered  according  to  the  act,  and  the  absence  of 


GEE  AT   BRITAIN  AND   IRELAND.  227 

the  name  of  any  person  from  such  copy  is  evidence,  until  the 
contrary  be  made  to  appear,  that  such  person  is  not  so  registered ; 
provided,  that  in  the  case  of  any  person  whose  name  does  not 
appear  in  such  copy,  a  certified  copy  under  the  hand  of  the  reg- 
istrar of  the  general  council  or  a  branch  council  of  the  entry  of 
the  name  of  such  person  on  the  general  or  local  register  shall 
be  evidence  that  such  person  is  so  registered  {ib.,  s.  27). 

If  any  college  or  body  exercise  any  power  it  possess  of  strik- 
ing off  from  its  list  the  name  of  any  one  of  its  members,  it  shall 
signify  his  name  to  the  general  council  and  the  said  council 
may,  if  they  see  fit,  direct  the  registrar  to  erase  from  the  regis- 
ter the  qualification  derived  from  such  college  or  body  in  respect 
of  which  such  member  was  registered,  and  the  registrar  shall 
note  the  same  therein,  but  the  name  of  no  person  shall  be  erased 
from  the  register  on  the  ground  of  his  having  adopted  any 
theory  of  medicine  or  surgery  (ib.,  s.  28). 

If  any  registered  medical  practitioner  shall  be  convicted  in 
England  or  Ireland  of  any  felony  or  misdemeanor,  or  in  Scot- 
land of  any  crime  or  offence,  or  shall  be  after  due  inquiry 
judged  by  the  general  council  to  have  been  guilty  of  infamous 
conduct  in  any  professional  respect,  the  general  council  may, 
if  they  see  fit,  direct  the  registrar  to  erase  the  name  of  such 
medical  practitioner  from  the  register  {ib.,  s.  29). 

Every  person  registered  who  may  have  obtained  any  higher 
degree  or  other  qualification  is  entitled  to  have  it  inserted  in 
the  register  in  substitution  for  or  in  addition  to  his  qualification 
previously  registered,  on  the  payment  of  such  fee  as  the  council 
may  appoint  {ib.,  s.  30). 

Compensation. — No  person  is  entitled  to  receive  for  any 
medical  or  surgical  advice,  or  attendance,  or  for  the  perform- 
ance of  any  operation  or  for  any  medicine  which  he  shall  have 
both  prescribed  and  supplied,  unless  he  prove  upon  the  trial 
that  he  is  registered  under  this  act  {ib.,  s.  32,  as  amended  23 
and  24  Vict.,  c.  7,  s.  3). 

Definition. — The  words  "legally  qualified  medical  practi- 
tioner" or  "duly  qualified  medical  practitioner,"  or  any  words 
implying  a  person  recognized  by  law  as  a  medical  practitioner 
or  member  of  the  medical  profession  in  any  act  of  Parliament, 
mean  a  person  registered  under  this  act  {ib.,  s.  34,  as  amended 
23  and  24  Vict.,  c.  7,  s.  3). 


228  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

Exemptions. — If  they  so  desire,  registered  persons  are 
exempt  from  serving  on  juries,  and  in  all  corporation,  par- 
ish, ward,  hundred,   and  town  offices,  and  in  the  militia  (ib., 

s.  35). 

Disqualifications. — No  unregistered  person  is  permitted 
to  hold  any  appointment  as  a  physician,  surgeon,  or  other 
medical  officer  in  the  military  or  naval  service,  or  in  emigrant 
or  other  vessels,  or  in  any  hospital,  infirmary,  dispensary,  or 
lying-in  hospital,  not  supported  wholly  by  voluntary  contribu- 
tions, or  in  any  lunatic  asylum,  jail,  penitentiary,  house  of 
correction  or  of  industry,  parochial  or  union  workhouse  or 
poorhouse,  parish  union,  or  other  public  established  body  or  in- 
stitution, or  to  any  friendly  or  other  society  for  affording  mutual 
relief  in  sickness,  infirmity,  or  old  age,  or  as  a  medical  officer 
of  health  {ib.,  s.  36,  as  amended  23  and  24  Vict.,  c.  7,  s.  3). 

No  certificate  required  by  any  act  from  any  phj^sician  or 
surgeon  licentiate  in  medicine  and  surgery,  or  other  medical 
practitioner,  is  valid  unless  the  signer  be  registered  under  this 
act  (ib.,  s.  37,  as  amended  23  and  24  Vict.,  c.  7,  s.  3). 

Penalty. — Wilfully  procuring  or  attempting  to  procure 
one's  seK  to  be  registered  by  making  or  producing  or  causing  to 
be  made  or  produced  an)-  false  or  fraudulent  representation  or 
declaration,  or  aiding  or  abetting  therein,  is  a  misdemeanor  in 
England  and  Ireland,  and  in  Scotland  a  crime  or  offence,  pun- 
ishable by  fine  or  imprisonment.  The  imprisonment  cannot 
exceed  twelve  months  {ib.,  s.  39). 

Wilfully  and  falsely  pretending  to  be  or  taking  or  using  the 
name  or  title  of  phj-sician,  doctor  of  medicine,  licentiate  in 
medicine  and  surger}-,  bachelor  of  medicine,  surgeon,  general 
practitioner,  or  apothecary,  or  any  name,  title,  addition,  or  de- 
scription implying  registration  under  this  act,  or  recognition 
by  law  as  a  physician  or  surgeon  or  licentiate  in  medicine 
and  surgery,  or  practitioner  in  medicine,  or  apothecary,  is  pun- 
ishable on  summary  conviction  by  a  penalty  not  exceeding  £20 
{ib.,  s.  40,  41). 

Deceased  Physicians. — Every  registrar  of  deaths  in  the 
United  Kingdom,  on  receiving  notice  of  the  death  of  any  medi- 
cal practitioner,  is  required  to  transmit  to  the  registrar  of  the 
general  council  and  the  registrar  of  the  branch  council  a  certifi- 
cate of  such  death  with  the  time  and  place,  and  on  the  receipt 


GREAT   BRITAIN   AND    IRELAND.  229 

of  such  certificate  the  medical  registrar  is  required  to  erase  the 
name  of  the  deceased  from  the  register  {ib.,  s.  45). 

Exceptions. — The  general  council  was  by  the  act  em- 
powered by  special  order  to  dispense  with  such  provisions  of 
this  act  or  such  part  of  any  regulations  made  by  its  authority 
as  to  them  should  seem  fit,  in  favor  of  persons  at  the  time  of  its 
passage  practising  medicine  or  surgery  in  any  part  of  Her  Maj- 
esty's dominions  other  than  Great  Britain  and  Ireland  by  virtue 
of  any  of  the  qualifications  in  Schedule  A,  and  in  favor  of  persons 
practising  medicine  or  surgery  within  the  United  Kingdom  on 
foreign  or  colonial  diplomas  or  degrees  before  the  passage  of 
this  act,  and  in  favor  of  any  persons  who  had  held  appointments 
as  surgeons  or  assistant  surgeons  in  the  army,  navy,  or  militia, 
or  in  the  service  of  the  East  India  Company,  or  who  were  act- 
ing as  surgeons  in  the  public  service,  or  in  the  service  of  any 
charitable  institution,  and  in  favor  of  medical  students  who 
commenced  their  professional  studies  before  its  passage  {ib., 
s.  46). 

The  qualifications  specified  in  Schedule  A  are  as  follows : 

1.  Fellow,  member  (inserted  22  Vict.,  c.  21,  s.  4),  licenti- 
ate, or  extra  licentiate  of  the  Royal  College  of  Physicians  of 
London  (this  is  declared  by  23  and  24  Vict.,  c.  06,  s.  1,  to  de- 
note the  corporation  of  "  The  President  and  College  or  Com- 
monalty of  the  Faculty  of  Physics  in  London").  (The  act 
makes  provision  for  a  new  charter  with  change  of  name  to  "The 
Royal  College  of  Physicians  of  England,"  or  retention  of  old 
name:  ib.,  s.  47,  as  amended  23  and  24  Vict.,  c.  66,  s.  2.) 

2.  Fellow,  member  (inserted  22  Vict.,  c.  21,  s.  4),  or 
licentiate  of  the  Royal  College  of  Physicians  of  Edinburgh. 
(The  act  makes  provision  for  the  granting  of  a  new  charter  to 
the  Royal  College  of  Physicians  of  Edinburgh,  whereby  its 
name  is  to  be  changed  to  "  The  Royal  College  of  Physicians  of 
Scotland,"  or  its  old  name  may  be  retained:  ib.,  s.  49,  as 
amended  23  and  24  Vict.,  c.  66,  s.  2.) 

3.  Fellow  or  licentiate  of  the  King's  and  Queen's  College  of 
Physicians  of  Ireland.  (The  act  makes  provision  for  the  grant- 
ing of  a  new  charter  to  this  college,  whereby  its  name  is  to  be 
changed  to  "  The  Royal  College  of  Physicians  of  Ireland , "  or 
its  old  name  may  be  retained:  ib.,  s.  51,  as  amended  23  and  24 
Vict.,  c.  m,  s.  2.) 


230  SYNOPSIS   OF   LAWS — POSTE    AND   BOSTON. 

4.  Fellow  or  member  or  licentiate  in  midwifery  of  the  Royal 
College  of  Surgeons  of  England. 

5.  Fellow  or  licentiate  of  the  Royal  College  of  Surgeons  of 
Edinburgh  (see  G,  below). 

G.  Fellow  or  licentiate  of  the  Faculty  of  Physicians  and 
Surgeons  of  Glasgow.  (The  act  makes  provision  for  the  possible 
amalgamation  of  the  Royal  College  of  Surgeons  of  Edinburgh 
with  the  Faculty  of  Physicians  and  Surgeons  of  Glasgow,  in 
which  case  the  united  corporation  is  to  be  named  "  The  Royal 
College  of  Surgeons  of  Scotland:"  ih.,  s.  50.) 

7.  Fellow  or  licentiate  of  the  Royal  College  of  Surgeons  in 
Ireland. 

8.  Licentiate  of  the  Society  of  Apothecaries,  London. 

9.  Licentiate  of  the  Apothecaries'  Hall,  Dublin. 

10.  Doctor  or  bachelor  or  licentiate  of  medicine,  or  master 
in  surgery  of  any  university  of  the  United  Kingdom ;  or  doctor 
of  medicine,  by  doctorate  granted  prior  to  the  passage  of  the 
act  by  the  Archbishop  of  Canterbury. 

11.  Doctor  of  medicine  of  any  foreign  or  colonial  university 
or  college,  practising  as  a  phj^sician  in  the  United  Kingdom 
before  October  1st,  1858,  who  shall  produce  certificates  to  the 
satisfaction  of  the  council,  of  his  having  taken  his  degree  of 
doctor  of  medicine  after  a  regular  examination,  or  who  shall 
satisfy  the  council  under  sec.  46  (amended  22  Vict.,  c.  21,  s.  5) 
of  this  act,  that  there  is  sufficient  reason  for  admitting  him  to 
be  registered. 

Nothing  in  the  above  act  shall  prevent  any  person,  not  a 
British  subject,  who  shall  have  obtained  from  any  foreign  uni- 
versity a  degree  or  diploma  of  doctor  in  medicine,  and  who 
shall  have  passed  the  regular  examinations  entitling  him  to 
practise  medicine  in  his  own  country,  from  being  and  acting  as 
the  resident  physician  or  medical  officer  of  any  hospital  estab- 
lished exclusively  for  the  relief  of  foreigners  in  sickness ;  pro- 
vided always  such  person  is  engaged  in  no  medical  practice 
except  as  such  resident  physician  or  medical  officer  (22  Vict., 
c.  21,  s.  6). 

The  following  qualification  was  added  by  23  and  24  Vict., 
c.  7,  s.  1: 

A  diploma  or  license  in  surgery  granted  by  any  university 
in  Ireland  legally  authorized  to  grant  the  same. 


GREAT    BRITAIN   AND    IRELAND.  231 

The  act  39  and  40  Vict.,  c.  40,  in  sec.  3,  provides  that  all 
persons  who  have  obtained  from  any  university  of  the  United 
Kingdom  legally  authorized  to  confer  the  same,  the  degree  of 
bachelor  in  surgery,  shall  be  permitted  to  register  the  same  as 
a  qualification  under  21  and  22  Vict.,  c.  90. 

The  diploma  of  a  member  of  the  King's  and  Queen's  Col- 
lege of  Physicians  in  Ireland,  and  the  degree  of  Master  in  Ob- 
stetrics of  anj^  university  in  the  United  Kingdom  are  added  to 
the  qualifications  in  Schedule  A  of  the  Medical  Act  of  1858 
(49  and  50  Vict.,  c.  48,  s.  20). 

The  change  of  name  of  any  of  the  corporations  named  in  21 
and  22  Vict.,  c.  90,  is  not  to  alter  or  afi^ect  the  qualifications 
constituted  by  the  act  (23  and  24  Vict.,  c.  G6,  s.  3). 

Revocation  of  License.— The  Society  of  Apothecaries  may 
strike  off  from  the  list  of  licentiates  of  said  society  the  name  of 
any  person  who  shall  be  convicted  in  England  or  Ireland  of  any 
felony  or  misdemeanor,  or  in  Scotland  of  any  crime  or  offence, 
or  who  shall,  after  due  inquiry,  be  judged  by  the  general  council 
to  have  been  guilty  of  infamous  conduct  in  any  professional 
respect,  and  the  said  society  shall  forthwith  signify  to  the  gen- 
eral council  the  name  of  the  licentiate  so  stricken  off  (37  and  38 
Vict.,  c.  34,  s.  4). 

Women. — The  Society  of  Apothecaries  is  not  relieved  from 
any  existing  obligation,  nor  deprived  of  any  right,  to  admit 
women  to  the  examinations  required  for  certificates  to  practise 
as  apothecaries,  or  to  enter  the  lists  of  licentiates  of  said  society, 
any  women  who  shall  have  satisfactorily  passed  such  examina- 
tions, and  fulfilled  the  other  general  conditions  imposed  upon 
persons  seeking  to  obtain  from  the  said  society  a  qualification  to 
be  registered  under  21  and  22  Vict.,  c.  90  {ih.,  s.  5). 

The  act  39  and  40  Vict.,  c.  41,  extends  the  powers  of  every 
body  entitled  under  21  and  22  Vict.,  c.  90,  to  grant  qualifica- 
tions for  registration  so  that  it  may  grant  any  qualification  for 
registration  granted  by  such  bodj-  without  distinction  of  sex — 
but  nothing  in  this  act  is  compulsory. 

The  Medical  Act  of  1886  (49  and  50  Vict.,  c.  48)  modified 
the  foregoing  acts  as  follows : 

Examination. — A  person  cannot  lawfull}"  be  registered 
under  the  medical  acts  in  respect  of  any  qualification  referred 
to  in  any  of  those  acts  unless  he  has  passed  such  qualifying  ex- 


232  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

amiiiation  in  medicine,  surgery,  and  midwifery  as  is  in  this 
act  mentioned  (49  and  50  Vict.,  c.  48,  s.  2). 

A  qualifying  examination  shall  be  an  examination  in  medi- 
cine, surgery,  and  midwifery  held  for  the  purpose  of  granting 
a  diploma  or  diplomas  conferring  the  right  of  registration  under 
the  medical  acts,  by  any  of  the  following  bodies : 

(a)  Any  university  in  the  United  Kingdom,  or  any  medical 
corporation  legally  qualified  at  the  time  of  the  passage  of  this 
act  to  grant  such  diploma  or  diplomas  in  respect  of  medicine 
or  surgery ;  or 

(b)  Any  combination  of  two  or  more  inedical  corporations 
in  the  same  part  of  the  United  Kingdom,  who  may  agree  to 
hold  a  joint  examination  in  medicine,  surgery,  and  midwifery, 
and  of  whom  one  at  least  is  capable  of  granting  such  diploma 
as  aforesaid  in  respect  of  medicine,  and  one  at  least  is  capable 
of  granting  such  diploma  in  respect  of  surgery ;  or 

(c)  Any  combination  of  any  such  university  as  aforesaid 
with  any  other  such  university  or  universities,  or  of  any  such 
university  or  universities  with  a  medical  corporation  or  cor- 
porations ;  the  bodies  forming  such  combination  being  in  the 
same  part  of  the  United  Kingdom  {ib.,  s.  3  [1]). 

The  standard  of  proficiency  at  said  examinations  shall  be 
such  as  suffices  to  guarantee  the  possession  of  knowledge  and 
skill  requisite  for  the  efficient  practice  of  medicine,  surgery, 
and  midwifery.  It  is  the  duty  of  the  general  council  to  secure 
the  maintenance  of  such  standard  of  proficiency,  and  it  may 
appoint  such  number  of  inspectors  as  it  may  determine  who 
shall  attend  at  all  or  any  of  the  said  examinations  {ib.,  s.  3  [2]). 

The  inspectors  are  not  to  interfere  with  the  conduct  of  any 
examination,  but  to  report  to  the  general  council  their  opinion 
as  to  the  sufficiency  or  insufficiency  of  every  examination  which 
they  attend,  and  such  other  matters  in  relation  thereto  as  the 
general  council  may  require  {ib.,  s.  3  [3]). 

If  it  appears  to  the  general  council  that  the  standard  of  pro- 
ficiencj'^  in  medicine,  surgery,  and  midwifery,  or  in  any  of  those 
subjects  or  any  branch  thereof  required  at  such  examinations 
by  any  such  body,  is  insufficient,  the  privy  council,  on  a  report 
from  the  general  council  after  considering  such  report,  and  any 
objection  thereto  by  any  body  to  which  it  relates,  may  by  order 
declare  that  the  examination  of  such  body  or  bodies  shall  not 


GREAT   BRITAIN   AND   IRELAND.  233 

be  deemed  a  qualifying  examination  for  registration,  and  Her 
Majesty,  with  the  advice  of  the  privy  council,  may  revoke  such 
order  if  upon  further  report  from  the  general  council,  or  any 
body  to  which  it  relates,  it  seems  to  her  expedient  {ih.^  s. 
4  [1]). 

During  the  continuance  of  such  order,  the  examinations  held 
hj  the  body  or  bodies  to  which  it  relates  shall  not  be  deemed 
qualifying  examinations,  and  a  diploma  granted  to  a  person 
passing  such  examinations  shall  not  entitle  such  person  to 
registration  {ib.,  s.  4  [2]). 

If  a  medical  corporation  represent  to  the  general  council 
that  it  is  unable  to  enter  into  a  combination  for  holding  a  qual- 
ifying examination,  and  the  general  council  is  satisfied  that  the 
said  corporation  has  used  its  best  endeavor  to  do  so  on  reason- 
able terms,  the  general  council  may  on  the  application  of  such 
corporation  appoint  any  number  of  examiners  to  assist  at  the 
examinations  for  granting  a  diploma  conferring  on  the  holder 
the  right  of  registration  {ih.^  s.  5  [1]). 

It  is  the  duty  of  the  said  assistant  examiners  to  secure  at 
the  said  examinations  the  maintenance  of  such  standard  of 
IDroficiency  in  medicine,  surgery,  and  midwifery  as  is  required 
from  candidates  at  qualifying  examinations,  and  any  exami- 
nation held  subject  to  this  section  shall  be  deemed  a  qualifying 
examination  {ih.,  s.  5  [2]). 

Practitioner's  Rights. — A  registered  medical  practitioner 
shall  be  entitled  to  practise  medicine,  surgery,  and  midwifery 
in  the  United  Kingdom,  and  subject  to  any  local  law,  in  any 
other  part  of  Her  Majestj^'s  dominions,  and  to  recover  in  due 
course  of  law  in  respect  of  such  practice,  any  expenses  or 
charges  in  respect  of  medicaments  or  other  appliances,  or  any 
fees  to  which  he  may  be  entitled,  unless  he  is  a  fellow  of  a 
college  of  physicians,  .the  fellows  of  which  are  prohibited  by  by- 
law from  recovering  at  law  their  expenses,  charges  or  fees,  in 
which  case  such  prohibitory  by-law,  so  long  as  it  is  in  force, 
may  be  pleaded  in  bar  of  any  legal  proceeding  instituted  by  such 
fellow  for  recovery  of  expenses,  charges,  or  fees  {ih.,  s.  6). 

Members  of  General  Council.  — The  constituent  members 
of  the  general  council  are  designated  by  this  act  in  sec.  7. 

Members  of  the  general  council  representing  the  registered 
medical  profession  must  themselves  be  registered  medical  prac- 


234:  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON. 

titioners,  and  members  of  the  branch  council  for  the  part  of  the 
United  Kiugxlom  in  which  they  are  elected  {ib.,  s.  8). 

Colonial  and  Foreign  Practitioners. — When  a  per- 
son shows  to  the  satisfaction  of  the  registrar  of  the  general 
council  that  he  holds  some  recognized  colonial  medical  diploma 
or  diplomas  granted  to  him  in  a  British  possession  to  which  this 
act  applies,  and  that  he  is  of  good  character,  and  is  by  law 
entitled  to  practise  medicine,  surger}^,  and  midwifery  in  such 
British  possession,  he  shall  on  application  to  the  said  registrar, 
and  on  the  paj^ment  of  such  fee  not  exceeding  £5,  as  the  general 
council  may  determine,  be  entitled  without  examination  in  the 
United  Kingdom  to  be  registered  as  a  colonial  practitioner  in 
the  medical  register ;  provided  he  proves  to  the  satisfaction  of 
the  registrar : 

(1)  That  the  said  diploma  or  diplomas  was  or  were  granted 
to  him  at  a  time  when  he  was  not  domiciled  in  the  United 
Kingdom,  or  in  the  course  of  a  period  of  not  less  than  five  years 
during  the  whole  of  which  he  resided  outside  of  the  United 
Kingdom;  or 

(2)  That  he  was  practising  medicine  or  surgery  or  a  branch 
of  medicine  or  surgery  in  the  United  Kingdom  on  the  pre- 
scribed day,  and  that  he  has  continued  practising  the  same 
either  in  the  United  Kingdom  or  elsewhere  for  not  less  than 
ten  years  immediately  preceding  the  prescribed  day  {ib.,  s. 
11). 

When  a  person  shows  to  the  satisfaction  of  the  registrar  of 
the  general  council  that  he  holds  some  recognized  foreign  med- 
ical diploma  or  diplomas  granted  in  a  foreign  country,  to  which 
this  act  applies,  and  that  he  is  of  good  character,  and  is  by  law 
entitled  to  practise  medicine,  surgery,  and  midwifery  in  such 
foreign  country,  he  shall  on  application  to  said  registrar,  and 
on  payment  of  such  fee,  not  exceeding  £5,  as  the  general  coun- 
cil may  determine,  be  entitled  without  examination  in  the 
United  Kingdom  to  be  registered  as  a  foreign  practitioner  in 
the  medical  register;  provided  he  proves  to  the  satisfaction  of 
the  registrar : 

(1)  That  he  is  not  a  British  subject;  or 

(2)  That,  being  a  British  subject,  the  said  diploma  or 
diplomas  was  or  were  granted  to  him  at  a  time  when  he  was 
not  domiciled  in  the  United  Kingdom  or  in  the  course  of  a 


GREAT  BRITAIN   AND   IRELAND.  235 

period  of  not  less  than  five  years,  during  the  whole  of  which 
he  resided  out  of  the  United  Kingdom ;  or 

(3)  That,  being  a  British  subject,  he  was  practising  medi- 
cine or  surgery,  or  a  branch  of  medicine  or  surgery  in  the 
United  Kingdom  on  the  prescribed  day,  and  that  he  has  con- 
tinued practisiug  the  same  in  the  United  Kingdom  or  elsewhere, 
for  not  less  than  ten  years  immediately  preceding  the  said  pre- 
scribed day  (?'&.,  s.  12). 

The  medical  diploma  granted  in  a  British  possession  or  for- 
eign country  to  which  this  act  applies,  which  is  to  be  deemed 
requisite,  shall  be  such  a  diploma  as  ma}^  be  recognized  by  the 
general  council  as  furnishing  a  sufficient  guarantee  of  the  pos- 
session of  the  requisite  knowledge  and  skill  for  the  efficient 
practice  of  medicine,  surgery,  and  midwifery. 

When  the  general  council  have  refused  to  recognize  any 
such  diploma,  the  privy  council  may,  on  appeal,  after  commu- 
nicating with  the  general  council,  order  the  general  council  to 
recognize  such  diploma. 

If  the  refusal  of  the  registration  of  a  colonial  or  foreign 
practitioner  be  on  any  other  ground,  the  registrar  of  the  gen- 
eral council  shall,  if  required,  state  in  writing  the  reason  for 
the  refusal,  and  the  person  refused  may  appeal  to  the  privy 
council,  which,  after  communicating  with  the  general  council, 
maj^  dismiss  the  appeal  or  order  the  general  council  to  enter  the 
name  of  the  applicant  on  the  register. 

A  person  may  be  registered  both  as  a  colonial  and  foreign 
practitioner  (z6.,  s.  13). 

The  medical  register  shall  contain  separate  lists  of  the  names 
and  addresses  of  colonial  and  foreign  practitioners,  and  the 
provisions  of  21  and  22  Vict.,  c.  90,  relating  to  persons  regis- 
tered and  to  the  medical  register,  and  to  offences,  shall  applj^  in 
the  case  of  colonial  and  foreign  practitioners  registered  under 
this  act  so  far  as  may  be  (ib.,  s.  14). 

Any  registered  practitioner  on  the  list  of  colonial  or  foreign 
practitioners  who  is  in  possession  of  or  obtains  any  recognized 
colonial  or  foreign  medical  diploma  granted  in  a  British  pos- 
session or  foreign  country  to  which  this  act  applies  may  cause 
a  description  of  such  diploma  to  be  added  to  his  name  in  the 
medical  register  {ib.,  s.  15). 

An}'  registered  medical  practitioner  on  the  medical  register 


236  SYNOPSIS   OP   LAWS — POSTE  AND   BOSTON, 

by  virtue  of  English,  Scotch,  or  Irish  quahfications,  and  in 
possession  of  a  foreign  degree  in  medicine,  may  cause  a  descrip- 
tion of  such  foreign  degree  to  be  added  to  his  name  as  an  addi- 
tional title  in  the  medical  register,  provided  he  satisfy  the 
general  council  that  he  obtained  such  degree  after  a  proper 
examination  and  prior  to  the  passage  of  this  act  {ib.,  s.  16). 

Her  Majesty  may  from  time  to  time,  by  order  in  the  coun- 
cil, declare  that  this  act  be  deemec\  to  apply  to  any  British  pos- 
session or  foreign  country  which  in  the  opinion  of  Her  Majesty 
affords  the  registered  medical  practitioners  of  the  United 
Kingdom  such  privileges  of  practice  in  the  said  British  pos- 
sessions or  foreign  countries  as  to  Her  Majesty  may  seem  just; 
and  on  and  after  the  day  named  in  such  order  such  British 
possession  or  foreign  country  shall  be  deemed  to  be  a  British 
possession  or  foreign  country  to  which  this  act  applies.  Her 
Majesty  may  also  renew  or  revoke  any  such  order,  and  upon 
such  revocation  such  possession  or  foreign  country  shall  cease 
to  be  a  possession  or  country  to  which  this  act  applies  without 
prejudice  to  the  right  of  any  person  whose  name  has  already 
been  entered  on  the  register  {ib.,  s.  17). 

Nothing  in  the  Medical  Act  of  1858  shall  prevent  a  person 
holding  a  medical  diploma,  entitling  him  to  practise  medicine 
or  surgery  in  a  British  possession  to  which  this  act  applies, 
from  holding  an  appointment  as  a  medical  officer  in  any  vessel 
registered  in  that  possession  {ib.,  s.  18). 

Default  of  General  Council. — In  default  of  the  gen- 
eral council  to  perform  any  duty,  the  privy  council  may  notify 
their  opinion  to  the  general  council,  and  on  the  failure  of  the 
general  council  to  comply  with  any  direction  of  the  privy 
council,  the  privy  council  may  themselves  give  effect  to  such 
direction,  and  for  that  purpose  exercise  any  power  vested  in 
the  general  council,  and  of  their  own  motion  do  anything  which 
they  are  authorized  to  do  in  pursuance  of  a  report  or  suggestion 
from  the  general  council  {ib.,  s.  19). 

Sanitary  Science. — Every  registered  medical  practitioner 
to  whom  a  diploma  for  proficiency  in  sanitarj"  science,  public 
health  or  state  medicine  has  after  special  examination  been 
granted,  by  any  college  or  facultj^  of  physicians  or  surgeons  or 
university  in  the  United  Kingdom,  or  by  anj-  such  bodies  act- 
ing in  combination,  shall,  if  such  diploma  appear  to  the  privy 


GREAT  BRITAIN   AND   IRELAND.  237 

council  or  general  council  to  deserve  recognition  in  the  medical 
register,  be  entitled  on  the  payment  of  such  fee  as  the  general 
council  may  appoint,  to  have  such  diploma  entered  in  the  said 
register  in  addition  to  any  other  diploma  or  diplomas  in  respect 
of  which  he  is  registered  {ib.,  s.  21), 

Evidence. — Any  act  of  the  privy  council  shall  be  suffi- 
ciently signified  by  an  instrument  signed  by  the  clerk  of  the 
council,  and  every  order  and  act  signified  by  an  instrument 
purporting  to  be  signed  by  the  clerk  of  the  council  shall  be 
deemed  to  have  been  dulj"  made  and  done  by  the  privj-  council, 
and  every  instrument  so  signed  shall  be  received  in  evidence 
without  proof  of  the  authority  or  signature  of  the  clerk  of  the 
council  or  other  proof  (^7>.,  s.  22). 

The  following  copies  of  any  orders  made  in  pursuance  of 
medical  acts  or  this  act  shall  be  evidence : 

(1)  Any  cop3"  purporting  to  be  printed  by  the  Queen's 
printer,  or  by  any  other  printer  in  pursuance  of  an  authority 
given  by  the  general  council, 

(2)  Any  copy  of  an  order  certified  to  be  a  true  copy  by  the 
registrar  of  the  general  council,  or  by  any  other  person  ap- 
pointed by  the  general  council,  either  in  addition  to  or  in  exclu- 
sion of  the  registrar,  to  certify  such  orders  (i6.,  s.  23). 

Rights  Unaffected. — This  act  does  not  vary  the  rights  of 
persons  practising  as  registered  medical  practitioners  on  the 
day  preceding  the  day  when  it  goes  into  effect  {ih.,  s.  24). 

In  consequence  of  the  repeal  of  any  enactment  repealed  by 
this  act,  no  person  legally  entitled  to  practise  as  a  medical  prac- 
titioner in  any  colony  or  part  of  Her  Majesty's  dominions  other 
than  the  United  Kingdom  shall  cease  to  be  so  entitled  if  he 
would  have  been  entitled  if  no  such  repeal  had  taken  place 
{ih.,  s.  25). 

Definitions. — In  the  act  the  word  diploma  means  any 
diploma,  degree,  fellowship,  membership,  license,  authority  to 
practise,  letters,  testimonial,  certificate  or  other  status  or 
document  granted  by  any  university,  corporation,  college,  or 
other  bod}^  or  by  any  departments  of  or  person  acting  under 
the  authority  of  the  government  of  an}'  countr}^  or  place  within 
or  without  Her  Majesty's  dominion  (/6.,  s.  27), 

Fees. — The  fees  are  to  be  determined  by  the  general  council 
within  the  limits  set  by  the  various  sections  authorizing  fees. 


238  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 


British  Columbia. 

Medical  Council. — There  is  a  body  styled  "The  Medical 
Council  of  British  Columbia, "  composed  of  seven  members  who 
are  registered  medical  practitioners  elected  by  the  votes  of 
registered  medical  practitioners  (Cons.  Acts  1888,  c.  81,  s.  2, 
3,  4,  5). 

No  person  can  lawfully  vote  at  such  election  unless  his  fees 
to  the  council  have  been  paid ;  and  no  person  is  eligible  to  elec- 
tion unless  qualified  to  vote  at  such  election  {ib.,  s.  1-1). 

A  register  of  such  qualified  voters  is  required  to  be  prepared 
by  the  registrar  of  the  council  and  no  person  is  entitled  to  vote 
whose  name  is  not  on  the  register ;  it  is  the  duty  of  the  regis- 
trar to  examine  into  the  written  complaint  of  any  medical  prac- 
titioner as  to  the  improper  omission  or  insertion  of  any  name 
in  the  list ;  and  appeal  from  his  decision  lies  to  a  judge  of  the 
supreme  court  in  a  summary  way,  whose  decision  shall  be  final, 
and  no  unregistered  person  may  vote  {ib.,  s.  16,  17). 

Register. — The  council  is  required  to  appoint  a  registrar 
and  to  cause  a  register  to  be  kept  by  him  of  the  names  of  all 
persons  who  have  complied  with  this  act  and  with  the  rules  and 
regulations  made  by  the  council  respecting  the  qualifications  of 
practitioners  of  medicine  or  surgery,  and  those  persons  only 
whose  names  are  inscribed  in  the  said  register,  are  deemed 
qualified  and  licensed  to  practise  medicine  or  surgery  except 
as  hereinafter  provided  (i5.,  s.  26). 

The  registrar  is  required  to  keep  his  register  correct,  and  to 
make  the  necessary  alterations  in  the  addresses  and  qualifica- 
tions of  registered  persons  (ib.,  s.  27). 

Qualification. — Every  person  at  the  passage  of  the  act 
(1886)  registered  under  the  medical  ordinance  of  1867  is  entitled 
to  be  registered  under  this  act  {ib.,  s.  28). 

The  council  is  required  to  admit  upon  the  .register  any  per- 
son who  shall  procure  from  any  college  or  school  of  medicine 
and  surgery  requiring  a  three-years'  course  of  stud}^,  a  diploma 
of  qualification,  provided  he  furnish  to  the  council  satisfactory 
evidence  of  identity  and  pass  before  the  members  thereof  a  sat- 
isfactory examination  touching  his  fitness  and  capability  to 
practise  as  a  physician  and  surgeon  {ib.,  s.  29). 


BRITISH   COLUMBIA.  339 

The  council  is  required  to  admit  upon  the  register  every 
person  mentioned  in  -tO  and  50  Vict.,  c.  48,  of  the  Acts  of  Par- 
liament of  the  United  Kingdom,  duly  registered  under  the  im- 
perial Medical  Act,  prior  to  and  inclusive  of  June  30th,  188.7, 
upon  complying  with  the  orders,  regulations  or  by-laws  of  the 
council  and  giving  due  proof  of  such  registration,  and  that  the 
person  applying  for  registration  has  not  lost  the  benefit  of  same 
by  reason  of  misconduct  or  otherwise,  and  upon  payment  of  the 
fees  fixed  by  the  council,  not  to  exceed  one  hundred  dollars 
(Act  1893,  c.  27,  s.  2). 

Duties  of  Council.— The  council  is  required  to  make 
orders,  regulations,  or  by-laws  for  regulating  the  register  and 
the  fees  to  be  paid  for  registration,  and  to  make  rules  and 
regulations  for  the  guidance  of  examiners,  and  may  prescribe 
the  subjects  and  modes  of  examination,  and  make  all  such 
rules  and  regulations  in  respect  of  examinations  not  contrary 
to  this  act  as  they  deem  expedient  and  necessary  (Cons.  Acts 
1888,  c.  81,  s.  31). 

Forfeiture  of  Right. — Any  registered  practitioner  con- 
victed of  any  felony  thereby  forfeits  his  right  to  registration 
and  by  direction  of  the  council  his  name  is  required  to  be  erased 
from  the  register,  or  in  case  a  person  known  to  have  been  con- 
victed of  felony  presents  himself  for  registration,  the  registrar 
has  power  to  refuse  such  registration  {ih.,  s.  32). 

Rights  of  Registered  Practitioner. — Every  person 
registered  under  the  act  is  entitled  to  practise  medicine  and 
surgery,  including  midwifery,  or  an}^  of  them  as  the  case  may 
be,  in  British  Columbia,  and  to  demand  and  receive  in  any 
court  of  the  province,  with  full  costs  of  the  suit,  reasonable 
charges  for  professional  aid,  advice,  and  visits,  and  the  costs 
of  any  medical  or  surgical  appliances  rendered  or  supplied  by 
him  to  his  patient  {ih.,  s.  33). 

Evidence. — The  registrar  of  the  council,  under  the  direction 
of  the  council,  is  required  to  publish  a  correct  register  of  the 
names  and  residences  with  the  medical  titles,  diplomas,  and 
qualifications  conferred  by  any  college  or  body,  of  all  persons 
appearing  on  the  register  at  the  date  of  publication.  Said  register 
is  called  "  The  British  Columbia  Medical  Register. "  A  copy 
of  such  register  for  the  time  being,  purporting  to  be  so  printed 
and  published,  shall  be  prima  facie  evidence  that  the  persons 


240  SYNOPSIS   OF  LAWS — POSTE  AND  BOSTON, 

therein  specified  are  registered  according  to  the  provisions  of 
this  act ;  and,  subject  to  sub.  sec.  2  of  this  section,  the  absence 
of  the  name  of  any  person  from  such  copy  shall  be  prnma  facie 
evidence  that  such  person  is  not  registered  according  to  this 
act  {lb.,  s.  34). 

In  the  case  of  a  person  whose  name  does  not  appear  in  such 
copy,  a  certified  copy  under  the  hand  of  the  registrar  of  the 
entry  of  the  name  of  such  person  on  the  register  shall  be  evi- 
dence that  such  person  i«  registered  under  this  act  (ib.,  s.  34, 
sub.  s.  2). 

Homoeopathic  Physicians. — Any  homoeopathic  physician 
holding  a  diploma  of  qualification  from  any  authorized  school 
or  college  requiring  a  three-years'  course  of  stud}"  may  be  regis- 
tered, and  shall  not  be  bound  to  pass  the  examination  required 
by  sec.  29,  but  in  lieu  thereof,  shall  pass  before  the  council,  or 
such  of  them  as  may  be  appointed  for  that  purpose,  a  satisfactory 
examination  in  anatomy,  physiology,  j^athology,  chemistry,  ob- 
stetrics, and  surgerj"  (ib.,  s.  35,  as  amended.  Act  1890,  c.  30,  s.  2). 

Neglect  to  Register. — Those  entitled  to  register  and 
neglecting  to  do  so  are  not  entitled  to  any  of  the  rights  and 
privileges  conferred  by  registration  and  are  liable  to  all  penalties 
against  unqualified  or  unregistered  practitioners  (ib.,  s.  37). 

Fraudulent  Registration. — If  a  person  procures  or 
causes  to  be  procured  his  registration  by  means  of  any  false  or 
fraudulent  representation  or  declaration,  the  registrar  may,  on 
receipt  of  sufficient  evidence  to  that  effect,  report  the  matter  to 
the  council  and,  on  the  written  order  of  the  president,  attested 
by  the  seal  of  the  council,  erase  the  name  of  such  person  from  the 
register  and  make  known  the  fact  and  the  cause  thereof  in  the 
British  Columbia  Gazette,  and  after  such  notice  has  appeared 
such  person  shall  cease  to  be  a  registered  practitioner,  and  to 
enjoy  any  of  the  privileges  conferred  by  registration,  without 
the  express  sanction  of  the  council  {ib.,  s.  39). 

To  wilfully  procure  or  attempt  to  procure  registration  by 
false  representations  or  declarations  is  punishable  by  a  penalty 
not  exceeding  $100.  To  knowingly  aid  or  assist  therein  is  pun- 
ishable with  a  penalty  of  from  $20  to  $50  for  each  offence  {ib., 
s.  40). 

Unlawful  Practices. —It  is  not  lawful  for  any  person 
not  registered  to  practise  medicine  or  surgery  for  hire,  gain. 


BRITISH   COLUMBIA.  241 

or  hope  of  reward.  To  so  practise  or  profess  to  practise,  or 
advertise  to  give  advice  in  medicine  or  surgery,  is  punishable 
with  a  penalty  of  from  $25  to  $100  {ib.,  s.  41). 

For  a  person  to  wilfully  or  falsely  pretend  to  be  a  phj'sician, 
doctor,  or  medical,  surgical,  or  general  practitioner,  or  assume 
any  title,  address,  or  description  other  than  he  actually  possesses 
and  is  legall}'  entitled  to,  is  punishable  by  a  penalty  of  from  $10 
to  $50  {ib.,  s.  12). 

A  person  not  registered  who  takes  or  uses  any  name,  title, 
addition,  or  description  implying  or  calculated  to  lead  people  to 
infer  that  he  is  registered  or  recognized  b}'  law  as  a  physician, 
surgeon,  or  licentiate  in  medicine  or  surgery  is  punishable  with 
a  penalty  of  from  $25  to  $100  {ib.,  s.  43). 

Costs  may  be  awarded  in  addition  to  the  penalty  against  an 
offender,  and  on  default  of  payment  he  may  be  committed  to 
the  common  jail  for  one  month  unless  the  costs  are  sooner 
paid  {ib.,  s.  47). 

Unregistered  Persons. — No  one  but  a  person  registered 
under  this  act  is  entitled  to  receive  any  charge  for  an}-  medical 
or  surgical  advice  or  attendance  or  the  performance  of  any  opera- 
tion or  for  any  medicine  that  he  may  have  prescribed  {ib.,  s.  44). 

Appointments  as  medical  officers,  physicians,  or  surgeons  in 
any  branch  of  the  public  service,  or  in  ^  hospital  or  a  charitable 
institution  not  supported  wholly  by  voluntary  contribution,  are 
conferred  on  registered  persons  only  {ib.,  s.  45). 

No  certificate  required  from  any  physician  or  surgeon  or 
medical  practitioner  is  valid  unless  the  signer  is  registered  {ib., 
s.  46). 

Evidence. — In  a  prosecution,  the  burden  of  proving  regis- 
tration is  upon  the  person  charged  {ib.,  s.  48). 

Registration  may  be  proved  by  the  production  of  a  printed 
or  other  copy  of  the  register  certified  under  the  hand  of  the 
registrar  of  the  council  for  the  time  being,  and  any  certificate 
on  such  copy  purporting  to  be  signed  by  any  person  as  registrar 
is  prima  facie  evidence  that  he  is  registrar  without  further 
proof  {ib.,  s.  49). 

Limitations. — Prosecutions  under  the  act  must  be  com- 
menced within  six  months  from  the  date  of  the  offence  {ib.,  s.  50). 

Stay. — The  council  may  stay  proceedings  in  prosecutions 
{ib.,s.  51). 

16 


242  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

Prosecutor. — Any  person  may  be  prosecutor  or  complain- 
ant under  the  act  (^6.,  s.  52). 

Fees. — To  the  registrar,  for  registration  under  this  act,  such 
sum  as  may  from  time  to  time  be  fixed  by  the  council  by  reso- 
lutions or  by-law,  but  not  exceeding  $100  {ib.,  s.  36,  as  amended, 
Act  1893,  c.  27,  s.  1). 

To  the  medical  council,  on  or  before  March  1st,  annually, 
$10,  or  such  other  sum  as  may  from  time  to  time  be  fixed  by 
the  council  {ih.,  s.  53,  as  amended,  Act  1890,  c.  30,  s.  3). 

For  registration,  by  persons  registered  under  Act  1893,  c. 
27,  s.  2,  a  fee  fixed  by  the  council  not  to  exceed  $100  (Act  1893, 
c.  27,  s.  2). 

Manitoba. 

College  of  Physicians  and  Surgeons.— The  medical 
profession  is  incorporated  as  "  The  College  of  Physicians  and 
Surgeons  of  Manitoba"  (Rev.  Stat,  of  Man.,  1891,  c.  98,  s.  2). 

All  persons  lawfully  registered  under  previous  acts  or  the 
present  act  are  members  of  the  said  college  {ib.,  s.  3,  4). 

Council. — There  is  constituted  by  law  a  council  of  the  said 
college  composed  of  representatives  selected  as  provided  in  the 
act,  each  of  whom  must  be  a  practitioner  licensed  under  this 
act  {ib.,  s.  5  to  8). 

No  member  of  the  college  who  is  in  arrears  for  his  annual 
fees  or  any  part  thereof  is  entitled  to  vote  at  the  election  for 
members  of  the  council  or  be  eligible  for  election  as  a  member 
thereof  {ib.,  s.  15), 

Register. — The  council  is  required  to  appoint  a  registrar 
and  to  cause  a  register  to  be  kept  in  which  shall  be  entered  the 
name  of  everj^  person  registered  under  this  act  or  under  the 
Consolidated  Statutes  of  Manitoba,  chap.  9,  and  the  acts  amend- 
ing the  same,  and  of  all  persons  who  comply  with  this  act,  and 
the  rules  and  regulations  made  by  the  council  respecting  the 
qualifications  of  practitioners  of  medicine,  surgery,  and  mid- 
wifery. Only  those  whose  names  are  inscribed  in  the  book  are 
deemed  qualified  and  licensed  to  practise  medicine,  surgery,  or 
midwifery  {ib.,  s.  17,  24,  25). 

Qualification. — All  persons  duly  registered  under  exist- 
ing laws  when  the  revised  statutes  took  effect  are  deemed  regis- 
tered under  the  present  law  {ib.,  s.  27). 


MANITOBA.  243 

The  registrar  was  required  immediately  upon  his  appoint- 
ment to  register  the  name  of  every  person  registered  under  pre- 
vious acts  {ib.,  s.  28). 

Every  person  who  possesses  one  or  more  of  the  following 
qualifications  shall,  upon  the  payment  of  the  fee,  to  be  fixed  for 
each  particular  class  by  by-law  of  the  council,  be  entitled  to  be 
registered  on  the  production  to  the  registrar  of  the  document 
proving  such  qualification : 

1.  Persons  entitled  to  be  registered  at  the  time  of  the  coming 
into  force  of  the  revised  statutes. 

2.  Any  member  of  any  incorporated  college  of  phj^sicians 
and  surgeons  of  any  province  of  the  Dominion  of  Canada,  or  any 
member  of  any  other  incorporated  body  of  medical  men  in 
Canada,  exercising  powers  similar  to  those  conferred  by  this 
act  on  the  College  of  Physicians  and  Surgeons  of  Manitoba, 
where,  by  the  laws  of  the  province  under  which  the  said 
incorporated  body  exists,  similar  rights  to  register  and  to  prac- 
tise medicine  are  granted  to  the  persons  incorporated  under 
this  act. 

3.  Every  person  mentioned  in  chap.  48  of  Act  49  and  50 
Vict,  of  the  Parliament  of  the  United  Kingdom. 

4.  Every  graduate  in  medicine  upon  examination  of  the 
University  of  Manitoba. 

5.  Every  person  who  produces  to  the  registrar  the  certificate 
under  the  corporate  seal  of  the  University  of  Manitoba  herein- 
after provided  for  (ib.,  s.  29). 

The  registrar  is  required  to  keep  his  register  correct,  and  to 
make  from  time  to  time  the  necessary  alterations  in  the  ad- 
dresses or  qualifications  of  the  persons  registered  {ib.,  s.  30). 

Every  person  registered  who  obtains  a  higher  degree  or 
other  qualification  is  entitled  to  have  it  inserted  in  the  register 
in  substitution  of  or  in  addition  to  the  qualification  previously 
registered,  on  the  payment  of  such  fees  as  the  council  may  ap- 
point {ib.,  s.  34). 

No  qualification  is  entitled  to  be  entered  on  the  register 
unless  the  registrar  be  satisfied  bj"  proper  evidence  that  the 
person  claiming  it  is  entitled  thereto.  Appeal  lies  from  the 
registrar's  decision  to  the  council  {ib.,  s.  35). 

The  registrar,  if  dissatisfied  with  the  evidence  adduced, 
may,  subject  to  appeal  to  the  council,  refuse  registration  until 


244  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

proper  evidence  is  furnished,  duly  attested  by  oath  or  affirma- 
tion before  a  judge  of  any  county  court  {ib.,  s.  30). 

Fraudulent  Registration. — Any  entry  proved  to  the 
satisfaction  of  the  council  to  have  been  fraudulently  or  incor- 
rectly made  may  be  erased  from  the  register  by  order  in  writ- 
ing of  the  council  {ib.,  s.  38). 

If  a  person  procures  or  causes  to  be  procured  his  regis- 
tration by  false  or  fraudulent  representations  or  declarations, 
the  registrar  may,  on  the  receipt  of  sufficient  evidence  of 
the  falsity  or  fraudulent  character,  represent  the  matter  to  the 
council,  and  may  on  the  written  order  of  the  president,  attested 
by  the  seal  of  the  college,  erase  his  name  from  the  register, 
and  cause  notice  of  the  fact  and  cause  to  be  published  in  the 
Manitoba  Gazette,  and  after  such  notice  has  appeared  such 
person  shall  cease  to  be  a  member  of  the  College  of  Physicians 
and  Surgeons,  and  to  enjoj^  any  privilege  enjoyed  or  conferred 
by  registration  at  any  further  time  without  the  express  sanction 
of  the  council  (ib.,  s.  39). 

Forfeiture  of  Rights. — An}-  registered  medical  practi- 
tioner convicted  of  felony  or  misdemeanor  before  or  after  the 
passage  of  the  act  or  his  registration  forfeits  his  right  to  regis- 
tration, and  by  direction  of  the  council  his  name  shall  be 
erased.  If  a  person  known  to  have  been  convicted  of  felony 
or  misdemeanor  presents  himself  for  registration,  the  registrar 
may  refuse  registration.  If  any  person  registered  be  judged, 
after  due  inquiry'  by  the  council,  to  have  been  guilty  of  in- 
famous or  unprofessional  conduct  in  any  respect,  the  council 
may  direct  the  registrar  to  erase  his  name  {ib.,  s.  40). 

The  council  may,  and  upon  the  application  of  any  three 
registered  medical  practitioners  shall,  cause  inquiry  to  be  made 
into  the  case  of  a  person  liable  to  have  his  name  erased  from 
the  register,  and  on  proof  of  such  conviction  or  such  infamous 
or  unprofessional  conduct  shall  cause  his  name  to  be  erased ;  but 
no  erasure  shall  be  made  on  account  of  his  adopting  or  refrain- 
ing from  adopting  the  practice  of  any  particular  theor}-  of  med- 
icine or  surgery,  nor  on  account  of  conviction  for  a  political 
offence  out  of  Her  Majesty's  dominions,  nor  on  account  of  the 
conviction  which  ought  not  in  the  opinion  of  the  council  or 
committee  disqualify  him  from  the  practice  of  medicine  or 
surgery  {ib.,  s.  41). 


MANITOBA.  .  245 

The  council  may  order  to  be  paid,  out  of  funds  at  their  dis- 
posal, such  costs  as  to  them  may  seem  just,  to  any  person  against 
whom  any  complaint  has  been  made  which,  when  fully  deter- 
mined, is  found  to  have  been  frivolous  and  vexatious  (^6.,  s.  42). 

An  entry  erased  by  order  of  the  council  shall  not  be  again 
entered  except  by  order  of  the  council  or  a  judge  or  court  of 
competent  jurisdiction  {ib.,  s.  43). 

If  the  council  think  fit,  they  may  direct  the  registrar  to  restore 
any  entry  erased,  without  a  fee,  or  on  payment  of  a  fee  not  ex- 
ceeding the  registration  fee,  as  the  council  may  fix  {ib.,  s.  44), 

The  council  is  authorized  to  ascertain  the  facts  of  any  case 
for  the  exercise  of  its  powers  of  erasing  and  restoring  by  com- 
mittee {ib.,  s.  45). 

The  act  provides  in  detail  for  proceedings  before  such  com- 
mittee {ib.,  s.  46  to  50). 

No  action  shall  be  brought  against  the  council  or  committee 
for  anything  done  bona  fide  under  the  act.  Appeal  from  the 
decision  to  erase  lies  to  any  judge  of  the  court  of  Queen's  Bench 
for  Manitoba,  and  such  judge  may  make  such  order  as  to  resto- 
ration or  confirmation  of  erasure  or  for  further  inquiry,  and  as 
to  costs,  as  to  him  may  seem  right  {ib.,  s.  51). 

Evidence. — In  a  trial  under  this  act  the  burden  of  proof 
as  to  registration  is  on  the  person  charged  {ib.,  s.  53). 

The  production  of  a  certificate  that  the  person  named  is  duly 
registered,  certified  under  the  hand  of  the  registrar,  is  sufficient 
evidence  of  registration,  and  his  signature  in  the  capacity  of 
registrar  is  prima /oc/e  evidence  that  he  is  registrar  without 
proof  of  signature  or  that  he  is  registrar  {ib.,  s.  54). 

The  registrar  is  required  to  print  and  publish  from  time  to 
time  under  the  direction  of  the  council  a  correct  register  of  the 
names  and  residences,  with  medical  titles,  diplomas,  and  qualifi- 
cations conferred  by  any  college  or  body,  with  the  date  thereof, 
of  all  persons  appearing  on  the  register  as  existing  on  the  day 
of  publication  {ib.,  s.  55).  The  register  is  called  "The  Man- 
itoba Medical  Register ;"  a  copy  thereof  for  the  time  being  pur- 
porting to  be  so  printed  and  published  is  prima  facie  evidence 
that  the  persons  specified  are  registered  {ib.,  s.  56). 

In  the  case  of  any  person  whose  name  does  not  appear  in 
such  copy,  a  certified  copy  under  the  hand  of  the  registrar  of 
the  council  of  the  entry  of  the  name  of  such  person  on  the  reg- 


246  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

ister  is  evidence  that  such  person  is  registered  {ib.,  s.  57).  The 
absence  of  the  name  of  any  person  from  such  copy  is  prima 
facie  evidence  that  he  is  not  registered  {ib.,  s.  58). 

Practitioner's  Eights. — Every  person  registered  is  en- 
titled according  to  his  qualifications  to  practise  medicine, 
surgery,  or  midwifery,  or  any  of  them  as  the  case  may  be,  and 
to  demand  and  recover  full  costs  of  suit,  reasonable  charges 
for  professional  aid,  advice,  and  visits,  and  the  cost  of  any  med- 
icine or  other  medical  appliances  rendered  or  supplied  by  him 
to  his  patient  {ib.,  s.  59). 

Neglect  to  Register. — A  person  neglecting  to  register  is 
not  entitled  to  the  rights  and  privileges  conferred,  and  is  liable 
to  all  penalties  against  unqualified  or  unregistered  practition- 
ers {ib.,  s.  60). 

Unregistered  Persons. — It  is  not  lawful  for  any  person 
not  registered  to  practise  medicine,  surgerj^  or  midwifery  for 
hire,  gain,  or  hope  of  reward  {ib.,  s.  61). 

No  person  is  entitled  to  receive  any  charge  for  medical  or 
surgical  advice  or  attendance,  or  the  performance  of  any  oper- 
ation, or  for  any  medicine  which  he  may  have  prescribed  or 
supplied,  unless  he  be  registered,  but  this  provision  does  not 
extend  to  the  sale  of  any  drug  or  medicine  by  a  licensed  chem- 
ist or  druggist  {ib.,  s.  62). 

No  person  can  be  appointed  as  a  medical  ofiicer,  physician, 
or  surgeon  in  the  public  service,  or  in  any  hospital  or  other 
charitable  institution  not  supported  wholly  by  voluntary  con- 
tribution, unless  he  be  registered  {ib.,  s.  63). 

No  certificate  required  from  any  physician  or  surgeon  or 
medical  practitioner  is  valid  unless  the  signer  be  registered 
{ib.,  s.  64). 

Definition. — The  expression  "legally  qualified  medical 
practitioner,"  or  any  other  words  importing  legal  recognition 
as  a  medical  practitioner  or  member  of  the  medical  profession, 
in  any  law,  is  construed  to  mean  a  person  registered  under  this 
act  {lb.,  s.  65). 

Immunities.  — A  person  registered  under  this  act  is  exempt 
from  jury  and  inquest  duty  if  he  desire  it  {ib.,  s.  66). 

Limitations. — No  dul}^  registered  member  of  the  College  of 
Physicians  and  Surgeons  is  liable  in  an  action  for  negligence 
or  malpractice  by  reason  of  professional  services  requested  or 


MANITOBA.  247 

rendered,  unless  it  be  commenced  within  one  year  from  the 
termination  of  such  service  {ib.,  s.  67). 

Examinations. — The  University  of  Manitoba  is  the  sole 
examining  body  in  medicine,  and  the  council  of  the  university 
may  grant  to  any  person  a  certificate  under  the  seal  of  the 
university  that  the  council  of  the  university  have  been  satisfied 
that  the  person  mentioned  in  the  certificate  is,  by  way  of 
medical  education  and  otherwise,  a  proper  person  to  be  regis- 
tered under  this  act ;  but  such  certificate  shall  not  be  granted 
until  the  person  making  such  application  shall  have  given 
evidence  of  qualification  by  undergoing  an  examination  or 
otherwise,  as  the  statutes  of  the  university  require,  and  the  ap- 
plicant shall  in  all  other  respects  first  comply  with  the  rules 
and  regulations  of  the  university  in  that  behalf  (ib.,  s.  68). 

HoMCEOPATHiSTS. — Until  a  homoeopathic  medical  college 
for  teaching  purposes  is  established  in  Manitoba,  in  the  case 
of  candidates  wishing  to  be  registered  as  homoeopathists,  the 
full  time  of  attendance  upon  lectures  and  hospitals  required  by 
the  university  statutes  may  be  spent  in  such  homoeopathic 
medical  colleges  in  the  United  States  or  Europe  as  may  be 
recognized  by  the  University  of  Manitoba  {ib.,  s.  69). 

Every  candidate  who  at  the  time  of  his  examination  signifies 
his  wish  to  be  registered  as  a  homceopathic  practitioner  shall 
not  be  required  to  pass  an  examination  in  materia  medica  or 
therapeutics,  or  theory  or  practice  of  physic,  or  in  surgery  or 
midwifery,  except  the  operative  practical  parts  thereof,  before 
any  examiners  other  than  those  homoeopathic  examiners  who 
shall  be  appointed  by  the  University  of  Manitoba  {ib.,  s.  70). 

Unlawful  Practices. — To  wilfully  procure  or  attempt 
to  procure  registration  by  false  or  fraudulent  representation  or 
declaration,  is  punishable  by  a  penalty  not  exceeding  $100.  To 
knowingly  aid  or  assist  therein,  is  punishable  by  a  penalty  of 
from  $20  to  $50  for  each  offence  {ib.,  s.  73). 

Persons  not  registered,  for  hire,  gain,  or  the  hope  of  reward, 
practising  or  professing  to  practise  medicine,  surgery,  or  mid- 
wifery, or  advertising  to  give  advice  in  medicine,  surgery,  or 
midwifery,  are  liable  to  a  penalt3^of  from  $25  to  $100  {ib.,  s.  74). 

A  person  wilfully  or  falsely  pretending  to  be  a  physician, 
doctor  of  medicine,  surgeon,  or  general  practitioner,  or  assum- 
ing a  title,  addition,  or  description  other  than  he  actualh'  pos- 


248  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTOTST. 

sesses  and  is  legall}'  entitled  to,  is  liable  to  a  penalty  of  from 
$10  to  $50  (ib.,  s.  75). 

For  a  person  to  assume  a  title  calculated  to  lead  people  to 
infer  that  he  is  registered,  or  is  recognized  by  law  as  a  physi- 
cian, surgeon,  or  accoacheur  or  a  licentiate  in  medicine,  surgery, 
or  midwifery,  is  punishable  with  a  penalty  of  from  $25  to  $100 
{ib.,  s.  70). 

On  prosecution,  costs  may  be  awarded  in  addition  to  the 
penalty,  and  the  offender  may  be  committed  to  the  common 
jail  for  one  month,  unless  the  penalty  and  costs  are  sooner  paid 
{ib.,  s.  78). 

Prosecutor. — Any  person  may  be  prosecutor  or  complain- 
ant under  the  act  {ib.,  s.  80). 

Limitations. — Prosecutions  are  limited  to  comrnence  within 
six  months  after  the  date  of  the  offence  {ib.,  s.  81). 

Appeal. — A  person  convicted  under  this  act,  giving  notice 
of  appeal,  must  before  being  released  give  satisfactory  security 
for  the  penalty  and  costs  of  conviction  and  appeal  {ib.,  s.  83). 

Stay. — The  council  may  stay  proceedings  in  prosecutions 
{ib.,  s.  84). 

Fees.— The  council  is  authorized  to  determine  by  by-law  an 
annual  fee,  which  is  required  to  be  paid  by  each  member  of  the 
college — the  fee  can  be  not  less  than  $2,  nor  more  than  $5,  is 
payable  on  January  1st,  and  may  be  recovered  as  a  debt  by  the 
college  {ib.,  s.  32). 

The  fee  for  registration  is  subject  to  regulation  by  the 
council  {ib.,  s.  33). 

New  Brunswick. 

Medical  Society. — All  persons  registered  under  the  act  con- 
stitute the  New  Brunswick  Medical  Society  (Act  1881,  c.  19,  s.  2). 

Council. — There  is  a  medical  council  called  the  Council  of 
Physicians  and  Surgeons  of  New  Brunswick,  of  nine  legally  qual- 
ified medical  practitioners,  of  not  less  than  seven  years'  standing ; 
four  are  nominated  and  appointed  by  the  governor  in  council, 
and  five  by  the  New  Brunswick  Medical  Societ}"  {ib.,  s.  3,  5). 

The  secretary  of  the  council  is  the  registrar  {ib.,  s,  7). 

Register,  Evidence. — The  registrar  is  required  before  May 
1st  annuall}"  to  print  and  publish  in  the  Royal  Gazette  of 
the  province,  and  such  other  manner  as  the  council  shall  ap- 


NEW   BRUNSWICK.  249 

point,  a  correct  register  of  the  names  and  residences  and 
medical  titles,  diplomas,  and  qualifications  conferred  by  any 
college  or  body,  with  the  dates  thereof,  of  all  persons  appearing 
on  the  register  on  the  1st  of  January.  The  register  is  called 
the  Medical  Register;  a  copy  for  the  time  being  purporting  to 
be  so  printed  and  published,  or  a  certificate  signed  by  the 
president  of  the  council,  and  attested  by  the  registrar  with 
the  corporate  seal  of  the  council,  is  p?"//» a /ac/e  evidence  that 
the  persons  therein  specified  are  registered  and  qualified ;  the 
absence  of  a  name  from  such  copy  or  the  want  of  such  certificate 
is  prima  facie  evidence  that  such  person  is  not  registered. 
If  a  name  does  not  appear  on  the  copy,  a  certified  copy,  under 
the  hand  of  the  registrar  of  the  council,  of  the  entry  of  a 
name  on  the  register  is  evidence  of  registration  {ih.,  s.  8). 

Entrance  upon  Study. — A  j)erson  beginning  or  entering 
on  the  study  of  physic,  surgery,  or  midwifery,  for  the  purpose 
of  qualifying  to  practise  in  the  province,  must  have  obtained 
from  the  council  a  certificate  that  he  has  satisfactorily  passed 
a  matriculation  or  preliminary  examination  in  the  subjects 
enumerated  in  the  act,  unless  he  has  passed  a  matriculation  ex- 
amination for  the  medical  course  in  arts  and  science  at  some 
college  in  Great  Britain,  Ireland,  Canada,  the  United  States 
of  America,  or  the  Continent  of  Europe  {ih.,  s.  10). 

The  act  prescribes  formalities  for  admission  to  such  prelim- 
inary examination  {ih.,  s.  10). 

Qualification. — Subject  to  the  exceptions  hereinafter,  no 
person  can  lawfully  practise  physic,  surgery,  or  midwifery  un- 
less he  be  registered,  or  unless  he  shall  have  received  from  the 
council  a  license  to  practise  {ih.,  s.  11). 

No  person  is  entitled  to  registration  or  license  unless  he  shall 
satisfy  the  council  that  he  has  passed  a  matriculation  or  prelim- 
inary examination ;  that  after  passing  such  examination  he  has 
followed  his  studies  for  not  less  than  four  years,  one  of  which 
may  be  under  the  direction  of  one  or  more  general  practitioners 
duly  licensed ;  that  during  such  four  years  he  has  attended  at 
some  university,  college,  or  incorporated  school  of  medicine  in 
good  standing,  courses  of  lectures  amounting  together  to  not 
less  than  twelve  months  on  general  anatomy,  on  practical  anat- 
omy, on  surgery,  on  practice  of  medicine,  on  midwifer}',  on 
chemistry,  on  materia  medica  and  pharmacy,  and  on  the  insti- 


250  SYNOPSIS   OP   LAWS — POSTE   AND    BOSTON. 

tntes  of  medicine  or  physic,  and  one  three-months'  course  of 
medical  jurisprudence;  that  he  has  attended  the  general  prac- 
tice of  an  hospital  in  which  are  not  less  than  fifty  beds  under 
the  charge  of  not  less  than  two  physicians  or  surgeons,  for  not 
less  than  one  year  or  two  periods  of  not  less  than  six  months 
each;  that  he  has  also  attended  two  three-months'  courses  or 
one  six-months'  course  of  clinical  medicine,  the  same  of  clinical 
surgery;  that  he  has,  after  an  examination  in  the  subjects  of 
the  course,  obtained  a  degree  or  diploma  from  such  universitj^, 
college,  or  incorporated  medical  school  if  such  institution  require 
a  four-years'  course  for  its  diploma,  or  for  the  want  of  such 
degree  or  diploma  that  he  has  satisfactorily  passed  an  exami- 
nation in  the  various  branches  hereinbefore  specified  before  the 
examiners  appointed  by  the  council ;  that  he  is  not  less  than 
twent3'-one  years  of  age;  that  he  has  paid  to  the  registrar  of 
the  council  a  fee  of  ten  dollars.  The  council  has  power,  subject 
to  the  approval  of  the  governor  in  council,  to  make  alterations 
as  may  be  required  in  the  foregoing  curriculum.  If  any  person 
apply  for  registration  as  a  practitioner  of  any  system  of  medi- 
cine, the  registered  practitioners  of  that  system  have  the  right 
to  appoint  an  examiner  or  examiners  on  the  subjects  peculiar  to 
that  sj'stem,  viz.,  materia  medica,  pharmacy,  and  therapeutics, 
and  if  they  neglect  so  to  do  the  council  has  the  power  to  appoint 
such  examiner  or  examiners  (ib.,  s.  12). 

The  last  preceding  section  does  not  applj^  to  persons  in 
actual  practice  entitled  to  register  under  sec.  38.  Any  person 
producing  to  the  council  conclusive  evidence  that  he  has  passed 
a  matriculation  or  a  preliminary  examination,  as  required  by 
this  act  for  persons  beginning  medical  studies  in  New  Bruns- 
wick, that  he  has  before  graduating  or  taking  a  diploma  studied 
at  least  four  years  as  provided  in  sec.  12,  or  pursued  what  the 
council  deem  an  equivalent  course  of  study  and  has  passed  a  final 
examination  in  the  subjects  of  such  course,  or,  for  the  want  of 
such  requirement,  shall  have  fulfilled  such  conditions  as  the 
council  may  determine,  and  shall  pay  a  fee  of  ten  dollars,  shall 
be  entitled  to  registration  and  to  receive  a  license  to  practise 
{ib.,s.  13). 

The  act  makes  special  provision  for  residents  of  the  prov- 
ince who  began  study  before  January  1st,  1881  {ib.,  s.  14,  as 
amended  1882,  c.  30,  s.  1). 


NEW  BEUNSWICK.  251 

Duties  of  Council. — The  council  is  empowered  and  re- 
quired to  regulate  the  study  of  medicine,  surgery,  and  midwife- 
ry, with  regard  to  preliminary  qualifications,  course  of  study, 
final  examination,  and  the  evidence  to  be  produed  before  the 
council ;  to  appoint  a  registration  committee ;  to  examine  all  de- 
grees, diplomas,  licenses,  and  other  credentials  presented  or  given 
in  evidence  under  the  act  to  enable  the  owner  to  practise  in  New 
Brunswick,  and  to  oblige  the  owner  to  attest  on  oath  or  affirma- 
tion that  he  is  the  person  whose  name  is  mentioned  therein,  and 
that  he  became  possessed  thereof  properly  and  honestly ;  to  cause 
every  member  of  the  profession  practising  in  New  Brunswick 
to  register  his  name,  age,  place  of  residence,  place  of  nativit}", 
date  of  license  or  diploma,  and  the  place  where  he  obtained  it ; 
to  appoint  medical  examiners,  who  may  be  members  of  the 
council,  to  hold  final  examinations,  who  shall  be  regularly 
qualified  practitioners  of  not  less  than  five  years'  professional 
standing  and  three  years'  residence  in  the  province  {ib.,  s.  15, 
as  amended  1882,  c.  30,  s.  2,  3). 

Correction  op  Register.  — The  registrar  is  required  to  erase 
the  names  of  all  registered  persons  who  shall  have  died,  left 
the  province  without  the  intention  of  returning,  or  ceased  to 
practise  for  five  years;  and  from  time  to  time  to  make  the 
necessary  alterations  in  the  addresses  or  qualifications  of  reg- 
istered persons.  Any  name  erased  shall  be  restored  by  the 
order  of  the  council  on  sufficient  cause  duly  shown  {ib.,  s.  18). 

Neglect  to  Register. — Persons  entitled  to  registration, 
neglecting  or  omitting  to  register,  are  not  entitled  to  any  rights 
or  privileges  conferred  by  the  act  {ib.,  s.  19). 

System  of  Practice. — No  person  otherwise  qualified  shall 
be  refused  registration  or  license  on  account  of  the  adoption  or 
the  refusal  to  adopt  the  practice  of  any  particular  theory  of 
medicine  or  surgery.  In  case  of  refusal  the  aggrieved  party 
may  appeal  to  the  governor  in  council,  who  is  required,  on 
due  cause  shown,  to  issue  an  order  to  the  council  to  register  his 
name  and  grant  him  a  license  to  practise,  and  thereupon  the 
council  shall  forthwith  register  his  name  and  grant  him  a 
license  to  practise  {ib.,  s.  20). 

Evidence  of  Qualification,  Fraudulent  Registra- 
tion.— No  qualification  can  be  entered  unless  the  registrar  be 
satisfied  by  proper  evidence  that  the  person  claiming  it  is  entitled 


252  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

to  it.  An  appeal  may  be  made  from  the  registrar's  decision  to 
the  council.  Any  entry  proved  to  the  satisfaction  of  the 
council  to  have  been  fraudulent!}'  or  incorrectly  made  may  be 
erased  by  the  order  in  writing  of  the  council,  and  the  name  of 
such  person  fraudulently  registering,  or  attempting  to  register, 
may,  at  the  discretion  of  the  council,  be  published  in  the  next 
issue  of  the  Royal  Gazette  {ib.,  s.  21). 

Forfeiture  of  Right.  — A  registered  medical  practitioner 
convicted  of  felony,  or  after  due  inquiry  judged  by  the  council 
to  have  been  guilty  of  infamous  conduct  in  any  professional 
respect  thereb}',  subject  to  appeal  to  the  governor  in  council, 
forfeits  his  right  to  registration,  and  by  the  direction  of  the 
council  his  name  shall  be  erased  from  the  register  {ib.,  s.  22). 

The  time  and  place  of  inquiry  under  "the  preceding  section 
must  be  fixed  by  the  council,  and  at  least  fourteen  days'  notice 
given  to  the  party  against  whom  inquiry  is  ordered  (Act  1886, 
c.  82,  s.  6). 

The  Act  of  1886,  c.  82,  regulates  the  procedure  on  such 
inquiry. 

Additional  Qualifications. — Every  person  registered 
who  may  obtain  a  higher  degree  or  other  qualification  is  en- 
titled to  have  it  registered  in  substitution  for,  or  in  addition  to, 
the  qualifications  previously  registered,  on  the  payment  of  such 
fee  as  the  council  may  demand  (Act  1881,  c.  19,  s.  23). 

Practitioner's  Rights. — Every  person  registered  under 
the  act  is  entitled  according  to  his  qualifications  to  practise 
medicine,  surgery,  midwifery,  or  dentistry,  or  either  or  anj^  of 
them  as  the  case  may  be,  and  to  demand  and  recover  reasonable 
and  customary  charges  for  professional  aid,  advice,  and  visits, 
and  the  cost  of  any  medicine  or  other  medical  or  surgical  ap- 
pliances rendered  or  supplied  by  him  to  his  patients  (ib.,  s.  24). 

No  person  is  entitled  to  recover  any  such  charge  unless  he 
shall  prove  upon  the  trial  that  he  is  registered  under  this  act 
{ib.,  s.  25). 

Definition. — The  words  "legally  qualified  medical  practi- 
tioner," or  "dulj"  qualified  medical  practitioner,"  or  other  words 
implying  that  a  person  is  recognized  by  law  as  a  medical  practi- 
tioner or  member  of  the  medical  profession,  when  used  in  a 
legislative  act  or  a  legal  or  public  document  mean  a  person  reg- 
istered under  this  act  {ib.,  s.  26). 


NEW   BRUNSWICK,  253 

Unregistered  Persons.— No  person  shall  be  appointed  a 
medical  officer,  physician,  or  surgeon  in  the  public  service  or 
in  any  hospital  or  other  charitable  institution  unless  registered 
{lb.,  s.  27). 

No  certificate  required  from  any  phj^sician  or  surgeon  or 
medical  practitioner  is  valid  unless  the  signer  be  duly  registered 
{ih.,  s.  28). 

A  person  not  registered  or  licensed,  and  not  actually  em- 
jDloyed  as  a  physician  or  surgeon  in  Her  Majesty's  naval  or 
military  service,  practising  physic,  surgery,  or  midwifery  for 
hire,  gain,  or  hope  of  reward,  forfeits  twenty  dollars  for  each 
day  of  such  practice  {ib.,  s.  29). 

The  sum  forfeited  is  recoverable  with  costs.  The  proced- 
ure in  reference  to  all  penalties  is  regulated  by  Act  of  188G,  c.  82. 

Persons  liable  as  provided  in  sees.  29  and  30  are  not  en- 
titled to  or  subject  to  the  provisions  of  any  act  for  the  relief  of 
debtors  (Act  1882,  c.  30,  s.  4). 

On  the  trial  of  such  cause,  the  burden  of  proof  as  to  license 
or  right  to  practise  is  upon  the  defendant  (Act  1881,  c.  19,  s. 
31;  Act  1886,  c.  82,  s.  3). 

Fraudulent  Registration. — Wilfully  procuring  or  at- 
tempting to  procure  registration  by  making  or  producing,  or 
causing  to  be  made  or  produced,  a  false  or  fraudulent  representa- 
tion or  declaration,  or  aiding  or  assisting  therein,  is  punishable 
with  a  forfeiture  of  not  less  than  $100  (Act  1881,  c.  19,  s.  33). 

Wilfully  or  falsely  pretending  to  be  or  using  anj'-  name  or 
description  implying  registration  is  punishable  with  a  forfeiture 
of  from  $50  to  $100  {ib.,  s.  34). 

Limitations. — No  prosecution  can  be  commenced  under 
the  act  after  one  year  from  the  date  of  the  offence  (Act  1886, 
c.  82,  s.  4). 

Exceptions. — The  act  does  not  prevent  persons  from  giving 
the  necessary  medical  or  surgical  aid  or  attendance  to  anj'  one 
in  urgent  need  of  it,  provided  it  be  without  gain,  and  the  giv- 
ing of  it  be  not  made  a  business  or  way  of  gaining  a  livelihood; 
nor  does  it  prevent  any  woman  from  giving  the  necessary  aid 
in  cases  of  confinement  as  heretofore  accustomed  (Act  1881,  c. 
19,  s.  36). 

Examination. — All  persons  who  subsequent  to  the  passage 
of  the  act  pass  the  examination  prescribed  by  the  council  of 


254  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

physicians  and  surgeons,  or  presenting  approved  credentials, 
certificates,  or  diplomas  equivalent  to  such  examination,  are 
entitled  to  register  and  receive  a  license  to  practise  {ib.,  s.  38), 

Physicians  in  Army  or  Navy. — A  person  while  employed 
in  actual  service  in  Her  Majesty's  naval  or  military  service  as 
a  physician  or  surgeon,  may  practise  physic,  surgery,  or  mid- 
wifery with  registry  or  license  (ib.,  s.  39). 

Non-Residents. — Non-resident  registered  practitioners  of 
medicine  residing  in  the  State  of  Maine  or  in  the  Province  of 
Quebec  or  Nova  Scotia  near  the  boundary  line  of  this  province 
whose  regular  practice  extends  into  any  town,  parish,  or  county 
in  New  Brunswick  may  register  under  the  act  {ib.,  s.  44). 

No  other  non-resident  practitioner  of  medicine  is  entitled  to 
register  (Act  1884,  c.  17,  s.  1). 

Exceptions. — The  act  does  not  extend  to  clairvoyant  physi- 
cians practising  at  the  time  of  its  passage  in  the  province,  nor  to 
midwives  (Act  1881,  c.  19,  s.  45). 

Students. — The  act  establishes  a  uniform  standard  of 
matriculation  or  preliminary  examinations  {ib.,  Sched.  B). 

Oaths. — Any  oath  or  affidavit  required  by  the  medical  act 
may  be  taken  before  any  justice  of  the  peace  or  person  by  law 
authorized  to  take  any  oath  or  affidavit  (Act  1882,  c.  30,  s.  6), 

Fees. — To  the  registrar,  for  registration  under  sees.  12  and 
13,  $10  (Act  1881,  c.  19,  s.  12  and  13). 

To  the  registrar,  for  the  registration  of  an  additional  quali- 
fication, such  fee  as  the  council  may  demand  (Act  1881,  c.  19, 
s.  23). 

To  the  registrar,  or  his  deputy,  annual  fee  from  each  prac- 
titioner, to  be  fixed  by  the  council,  not  more  than  $2  nor  less 
than  $1  (Act  1882,  c.  30,  s.  5). 

Each  registered  medical  practitioner  must,  if  required  by  the 
council,  pay  to  the  registrar,  or  a  person  deputed  by  him,  an 
annual  fee  determined  hj  the  council,  not  less  than  $1  nor  more 
than  $2,  payable  January  1st  each  year,  and  recoverable  as  a 
debt  with  costs  in  the  name  of  the  council  (Act  1882,  c.  30, 
s.  5). 

If  any  practitioner  omit  to  pay  the  registration  fee  before 
the  registrar  causes  the  register  to  be  printed  in  the  Royal 
Gazette,  the  registrar  shall  not  cause  the  name  of  such  practi- 
tioner to  be  printed,  and  he  shall  thereupon  cease  to  be  deemed 


NEW   BRUNSWICK — NEWFOUNDLAND.  355 

a  registered  practitioner ;  but  afterward,  on  paying  such  fee,  he 
shall  be  entitled  to  all  his  rights  and  privileges  as  a  registered 
practitioner  from  the  time  of  payment  (Act  1884,  c.  17,  s.  2). 

Newfoundland. 

Medical  Board. — There  is  a  board  composed  of  seven 
regularly  qualified  medical  practitioners  of  not  less  than  five 
years'  standing,  appointed  as  provided  in  the  act,  and  known 
as  the  "Newfoundland  Medical  Board,"  whose  duties  relate, 
among  other  things,  to  the  making  and  enforcing  of  measures 
necessary  for  the  regulation  and  the  practice  of  medicine  (Act 
1893,  c.  12,  s.  2,  3,  19). 

The  board  is  authorized  to  appoint  examiners  and  fix  times 
of  examinations  {ib.,  s.  5). 

The  secretary  of  the  board  is  the  registrar  {ib.,  s.  7). 

Register,  Evidence. — It  is  the  duty  of  the  registrar  on 
or  before  January  1st  in  each  year  to  cause  to  be  published 
in  the  Royal  Gazette  of  Newfoundland  a  list  of  the  names  of 
all  persons  appearing  on  the  register  at  that  date,  with  their 
places  of  residence,  titles,  diplomas,  and  qualifications  as  con- 
ferred by  any  college  or  body,  with  the  date  {ib.,  s.  8). 

Such  register  is  called  the  Medical  Register,  and  a  cop}- 
thereof  is  prima  facie  evidence  that  the  persons  therein  speci- 
fied are  registered  according  to  the  act ;  and  the  absence  of  a 
name  therefrom  is  prima  facie  evidence  that  such  person  is 
not  so  registered  {ib.,  s.  9). 

Qualification. — The  members  of  the  board  form  a  body  of 
medical  examiners  of  diplomas  and  degrees,  whose  certificate 
shall  be  the  only  license  permitting  the  practice  of  medicine, 
surgery,  or  midwifery,  except  as  hereinafter  provided,  provided 
the  applicant  for  such  license  shall  previously  have  obtained  a 
medical  diploma  from  a  recognized  college  or  universit}*,  or  as 
hereinafter  provided  {ib.,  s.  10.) 

Every  person  is  entitled  to  have  his  name  entered  on  the 
register  on  satisfying  the  board  that  he  holds  a  degree  or 
diploma  from  some  regular  university  or  school  of  medicine 
in  good  standing,  and  he  shall  then  receive  from  the  board  a 
license  bearing  its  seal,  on  the  payment  to  the  registrar  of  $5, 
and  shall  have  his  name  entered  on  the  register  {ib.,  s.  11). 


256  SYNOPSIS   OP   LAWS — POSTE   AND    BOSTON. 

No  such  licensed  practitioner  shall  be  entitled  to  practise  in 
•Ally  year  without  taking  out  from  the  board,  before  the  1st  of 
January  in  every  year,  a  certificate  of  practice  for  which  he 
shall  pay  $1  {ib.,  s.  12). 

Students. — The  act  provides  the  requirements  for  entering 
on  the  study  of  medicine,  surgery,  or  midwifery  in  the  colony 
{ib.,  s.  13,  14,  17). 

Duties  of  Board. — The  board  is  required  to  examine  all 
degrees  and  other  credentials  produced  or  given  in  evidence 
under  the  act  for  the  purpose  of  enabling  the  owners  to  practise, 
and,  if  it  be  deemed  necessary,  to  oblige  the  owner  to  attest  on 
oath  or  affidavit  that  he  is  the  person  whose  name  is  mentioned 
therein,  and  that  he  has  become  possessed  of  the  same  by  lawful 
means  (ib.,  s.  16). 

The  board  is  required  to  cause  every  member  of  the  profes- 
sion practising  in  Newfoundland  to  enter  his  name,  age,  place 
of  residence,  date  of  license  or  diploma  and  where  it  was  ob- 
tained, on  the  register  {ib.,  s.  18). 

Neglect  to  Register. — A  person  entitled  to  be  registered, 
who  neglects  or  omits  to  apply,  is  not  entitled  to  any  of  the  rights 
or  privileges  conferred  by  the  act  so  long  as  the  neglect  or 
omission  continues  {ib.,  s.  25). 

Additional  Qualification. — A  person  registered  who 
obtains  a  higher  degree  or  diploma  is  entitled  to  have  it  inserted 
in  the  register  in  addition  to  or  in  substitution  for  those  pre- 
viously registered  {ib.,  s.  26). 

Rights  of  Registered  Persons. — A  person  properly 
registered  under  the  act  is  entitled  to  practise  medicine, 
surgery,  and  midwifery  in  any  part  of  the  colony,  and  to  de- 
mand and  recover  reasonable  charges  for  professional  aid  or 
advice  with  the  cost  of  medicine  or  other  medical  and  surgical 
appliance  supplied  by  him  {ib.,  s.  27). 

Unregistered  Persons. — No  person  whose  name  is  not  reg- 
istered under  the  act  is  entitled  to  recover  any  fees  for  any  medi- 
cal or  surgical  advice,  or  for  any  services  whatsoever  rendered 
in  the  capacity  of  a  medical  man,  nor  to  recover  the  payment  of 
charges  for  any  medicine  or  medical  or  surgical  appliance  which 
maj^  have  been  both  prescribed  and  supplied  bj^  him.  This 
clause  is  not  intended  to  interfere  with  the  practice  of  midwifery 
by  competent  females  as  hereinafter  provided  {ib.,  s.  28). 


NEWFOUNDLAND.  257 

Offences  and  Penalties. — Except  as  hereinafter  provided, 
if  a  person  not  registered  or  licensed  under  the  act  practises 
medicine,  surgery,  or  midwifery  for  hire,  gain,  help  [sic]  or 
reward,  or  wilfully  and  falsely  pretends  to  be  a  physician,  doctor 
of  medicine,  surgeon,  or  general  practitioner,  or  takes  or  uses 
any  name,  title,  addition  [or]  description,  implying  or  calculat- 
ing [sic]  to  deceive  or  lead  the  public  to  infer  that  he  is  regis- 
tered under  this  act,  or  who  proposes  by  public  advertisement, 
card,  circular,  or  otherwise,  to  practise  medicine,  surgery,  or 
midwifery,  or  give  advice  therein,  or  in  anywise  lead  people 
to  infer  that  he  is  qualified  to  practise  medicine,  surgerj^,  or 
midwifery,  he  shall  forfeit  $20  for  each  daj'  that  he  so  prac- 
tises or  leads  people  to  infer  that  he  is  a  practitioner,  or  shall 
suffer  imprisonment  not  exceeding  twelve  months  (ib.,  s.  29). 

Persons  violating  the  above  regulations  are  subject  to  the 
penalties  of  the  act^  and  in  all  cases  the  burden  of  proof  as  to 
qualification  is  upon  the  defendant  or  practitioner  {ib.,  s.  30). 

Expulsion  of  Member. — The  Newfoundland  Medical 
Board  may  try  and  expel  any  member  of  the  profession  for 
acts  of  malpractice,  misconduct,  or  immoral  habits,  provided 
five-sevenths  of  the  whole  number  record  their  signatures  to 
such  a  measure  {ib.,  s.  32). 

Exceptions. — The  act  does  not  prevent  private  persons 
from  giving  the  necessary  medical  or  surgical  aid  in  times  of 
urgent  need,  provided  such  aid  or  attention  is  not  given  for 
gain  or  hire,  nor  the  giving  of  it  made  a  business  or  a  way  of 
gaining  a  livelihood  {ib.,  s.  34). 

Every  person  residing  in  the  colony  and  who  shall  have 
practised  medicine,  surgery,  and  midwifery  for  five  years  con- 
secutively in  one  locality  previous  to  the  passage  of  the  act,  on 
the  proof  of  the  same,  shall  have  his  name  registered  and  receive 
a  license  to  practise  under  the  act ;  provided,  the  board  may 
grant  a  license  to  any  person  who  may  have  practised  for  a 
shorter  period,  on  being  satisfied  b}^  examination,  or  inquiry, 
that  such  person  is  reasonably  competent  and  fit;  and  further 
provided,  that  the  board  may,  after  examination  and  inquiry, 
license  persons  with  a  reasonable  amount  of  competence  to  prac- 
tise in  specified  localities,  in  which  no  qualified  practitioners 
reside  {ib.,  s.  37). 

Any  person  while  employed  in  actual  service  in  any  naval 


258  SYNOPSIS   OF   LAWS— POSTE   AND    BOSTON. 

or  military  service  as  physician  or  surgeon  may  practise  medi- 
cine, surgery,  and  midwifery  after  having  been  registered  {ib., 
s.  38). 

Definition. — The  words  "  legally  qualified  medical  practi- 
tioner" or  "  duly  qualified  medical  practitioner, "  or  any  other 
words  importing  a  person  recognized  by  law  as  a  medical 
practitioner  or  a  member  of  the  medical  profession,  when  used 
in  any  act  of  the  legislature  or  legal  or  public  document,  mean 
a  person  registered  under  this  chapter,  unless  as  otherwise  pro- 
vided {ib.,  s.  39). 

Medical  Appointments. — No  person  shall  be  appointed  as 
a  medical  officer,  physician,  or  surgeon  in  any  branch  of  the 
public  service  or  any  hospital  or  other  charitable  institution  un- 
less he  be  registered  under  the  provisions  of  this  chapter  (^6,, 
s.  40). 

Theories  of  Medicine  orSurgerv. — No  person  otherwise 
fully  qualified  shall  be  refused  registration,  or  a  license  to 
practise,  on  account  of  his  adopting  or  refusing  to  adopt  the 
practice  of  any  particular  theory  of  medicine  or  surgery.  In 
case  of  such  refusal  by  the  board,  the  part}^  aggrieved  may 
appeal  to  the  governor  in  council,  who,  on  due  cause  shown,  shall 
issue  an  order  to  the  board  to  register  the  name  of  such  person 
and  grant  him  a  license  (ib.,  s.  41). 

MiDWivES. — The  act  does  not  prevent  competent  females 
from  practising  midwifery  {ib.,  s.  42) r 

Fees. — To  the  registrar,  for  license,  $5  (ib.,  s.  11). 

To  the  board,  each  year,  for  a  certificate  of  practice,  $1  {ib.y 
s.  12). 

Northwest  Territories. 

College  of  Physicians  and  Surgeons. — The  members  of 
the  medical  profession  are  a  body  corporate  under  the  name 
of  "The  College  of  Physicians  and  Surgeons  of  the  North- 
west Territories"  (Ord.  5  of  1888,  s.  2). 

Every  person  registered  according  to  Ordinance  11  of  1885 
is  a  member  of  the  said  college  and  shall  be  held  to  be  registered 
under  this  ordinance  from  the  date  of  its  passage  {ib.,  s.  3,  as 
amended  Ord.  9  of  1891-92). 

Every  person  registered  under  this  law  is  a  member  of  the 
college  {ib.,  s.  4). 


NEWFOUNDLAND — NORTHWEST   TERRITORIES.  259 

Council. — There  is  a  council  of  said  college  elected  by  the 
members  from  the  members  registered  in  pursuance  of  this 
ordinance  {ib.,  s.  5,  6,  7). 

The  council  appoints  among  other  officers  a  registrar  {ib., 
s.  26). 

Register,  Qualification. — Persons  registered  under  Or- 
dinance 11  of  1885  are  entitled  to  register  under  this  ordinance 
{lb.,  s.  31). 

The  council  is  required  to  cause  the  registrar  to  keep  a 
register  of  the  names  of  all  persons  who  have  complied  with 
this  ordinance,  and  the  rules  and  regulations  of  the  council 
respecting  the  qualifications  required  from  practitioners  of  med- 
icine or  surgery.  Only  those  persons  whose  names  are  inscribed 
in  the  register  are  deemed  qualified  and  licensed  to  practise 
medicine  or  surgery,  except  as  hereinafter  provided  {ib.,  s.  32). 

The  registrar  is  required  to  keep  his  register  correct  and  to 
make  the  necessary  alterations  in  the  addresses  or  qualifica- 
tions of  persons  registered  {ib.,  s.  33). 

The  council  is  required  to  admit  on  the  register : 

(a)  Any  person  possessing  a  diploma  from  any  college  in 
Great  Britain  and  Ireland  (having  power  to  grant  such  di- 
ploma) entitling  him  to  practise  medicine  and  surgery,  and  who 
shall  produce  such  diploma  and  furnish  satisfactory  evidence 
of  identification ; 

(6)  any  member  of  the  College  of  Physicians  and  Surgeons 
of  the  Provinces  of  Manitoba,  Ontario  and  Quebec  upon  pro- 
ducing satisfactory  evidence  of  the  same  and  of  identification ; 

(c)  any  person  who  shall  produce  from  any  college  or  school 
of  medicine  and  surgery  in  the  Dominion  of  Canada  requiring  a 
four-years'  course  of  study  and  {sic)  a  diploma  of  qualification ; 
provided  he  furnish  to  the  council  satisfactory  evidence  of  iden- 
tification, and  pass  if  deemed  necessary,  before  the  members 
thereof,  or  such  examiners  as  may  be  appointed  for  the  purpose, 
a  satisfactory  examination  touching  his  fitness  and  capacity  to 
practise  as  a  physician  and  surgeon,  upon  payment  to  the  regis- 
trar of  fifty  dollars  {ib.,  s.  34,  as  substituted  by  Ord.  14,  1890, 
amended  by  Ord.  9,  1891-92). 

Powers  of  Council. — The  members  of  the  council  are 
required  to  make  orders,  regulations,  or  by-laws  for  the  regula- 
tion of  the  register  and  the  guidance  of  examiners,  and  may 


260  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

prescribe  subjects  and  modes  of  examination,  and  may  make 
all  regulations  in  respect  of  examinations,  not  contrary  to  the 
ordinance,  that  they  may  deem  expedient  and  necessary  (ib., 
s.  36). 

The  council  may  by  by-law  delegate  to  the  registrar  power 
to  admit  to  practice  and  to  register  any  person  having  the  nec- 
essary qualifications  entitling  him  to  be  registered  by  the  coun- 
cil (Ord.  24,  1892,  s.  4). 

The  council  may  direct  the  name  of  any  person  improperly 
registered  to  be  erased  from  the  register  and  such  name  shall 
be  erased  by  the  registrar  (Ord.  24,  1892,  s.  5). 

Forfeiture  of  Rights. — If  a  medical  practitioner  be  con- 
victed of  any  felony  or  misdemeanor  or  after  due  inquiry  be 
judged  by  the  council  to  have  been  guilty  of  infamous  conduct 
in  any  professional  respect,  the  council  may,  if  it  sees  fit,  direct 
the  registrar  to  erase  the  name  of  such  practitioner  from  the 
register,  and  the  name  shall  be  erased  (Ord.  5, 1888,  s.  37,  as 
substituted  by  Ord.  24,  1892,  s.  1). 

Rights  of  Registered  Persons. — Every  person  registered 
under  the  ordinance  is  entitled  to  practise  medicine  and  surgery, 
including  midwifery,  or  anj^  one  of  them,  as  the  case  may  be, 
and  to  demand  and  recover  with  costs  his  reasonable  charges  for 
professional  aid,  advice,  and  visits,  and  the  cost  of  medical  or 
surgical  appliances  rendered  or  supplied  by  him  to  his  patients 
[ib.,  s.  38). 

Limitation. — A  period  of  one  year  after  the  term  of  pro- 
fessional service  is  established  as  a  limitation  to  actions  for 
negligence  or  malpractice  against  members  of  the  college  {ib., 
s.  39). 

Register,  Evidence. — The  registrar,  under  the  direction 
of  the  council,  is  required  to  publish  a  register  of  the  names  and 
residences  and  the  medical  titles,  diplomas,  and  qualifications 
conferred  by  any  college  or  body,  of  all  persons  appearing  on  the 
register  on  the  day  of  publication.  The  register  is  called 
"Northwest  Territories'  Medical  Register,"  and  a  copy  for  the 
time  being,  purporting  to  be  so  printed  and  published,  is  prima 
facie  evidence  that  the  persons  therein  specified  are  registered 
according  to  the  act.  The  absence  of  a  name  from  such  copy  is 
prima  facie  evidence  that  such  person  is  not  so  registered. 

In  case  a  person's  name  does  not  appear  on  such  copy,  a  cer- 


NORTHWEST   TERRITORIES.  201 

tified  copy  under  the  hand  of  the  registrar  of  the  entry  of  the 
name  of  such  person  on  the  register  is  evidence  that  such  person 
is  registered  {ib.,  s.  40). 

Neglect  to  Register. — A  person  neglecting  to  register  is 
not  entitled  to  the  rights  or  privileges  conferred  and  is  liable  to 
all  penalties  against  unqualified  or  unregistered  practitioners 
{ib.,  s.  4). 

Offences  and  Penalties. — To  practise  or  jDrofess  to  prac- 
tise without  registration,  for  hire  or  reward,  is  punishable  with 
a  penalty  of  $100  {ib.,  s.  42). 

To  wilfully  or  falsely  pretend  to  be  a  physician,  doctor  of 
medicine,  surgeon,  or  general  practitioner,  or  assume  any  title 
or  description  not  actually  possessed  and  to  which  the  person  is 
not  legally  entitled  under  this  ordinance,  is  punishable  with  a 
penalt}^  of  from  $10  to  $50  {ib.,  s.  43,  as  amended  by  Ord.  24, 
1892,  s.  2). 

To  take  or  use  a  name  or  description  implying  or  calculated 
to  lead  people  to  infer  registration  or  recognition  by  law  as  a 
physician,  surgeon,  or  licentiate  in  medicine  or  surgery  is  pun- 
ishable with  a  penalty  of  from  $25  to  $100  {ib.,  s.  44). 

Unregistered  Persons. — No  person  is  entitled  to  recover 
for  any  medical  or  surgical  advice  or  attendance  or  the  perfor- 
mance of  anj'  operation  or  medicine  which  he  may  have  pre- 
scribed {ib.,  s.  45) ;  nor  to  be  appointed  as  medical  officer,  physi- 
cian, or  surgeon  in  any  branch  of  the  public  service  or  in  any 
hospital  or  other  charitable  institution  not  supported  wholly  bj' 
voluntary  contributions,  unless  registered  {ib.,  s.  46). 

No  certificate  required  from  a  physician  or  surgeon  or  med- 
ical practitioner  is  valid  unless  the  signer  is  registered  {ib., 
s.  47). 

Costs. — In  prosecutions,  payment  of  costs  may  be  awarded 
in  addition  to  the  penalt}^  and  in  default  of  payment  the  offender 
may  be  committed  to  the  common  jail  for  not  more  than  one 
month  {ib.,  s.  48). 

Burden  of  Proof. — In  prosecutions,  the  burden  of  proof 
as  to  registration  is  upon  the  person  charged  {ib.,  s.  49). 

Proof. — The  production  of  a  printed  or  other  copj'  of  the 
register,  certified  under  the  hand  of  the  registrar,  for  the  time 
being  is  sufficient  evidence  of  all  persons  [registered] ;  a  certifi- 
cate on  such  copy  purporting  to  be  signed  by  any  person  in  the 


202  SYNOPSIS   OF   LAWS— POSTE   AND   BOSTON. 

capacity  of  registrar  of  the  council  under  this  ordinance  isprima 
facie  evidence  that  he  is  registered  without  proof  of  his  signa- 
ture or  of  his  being  in  fact  registrar  {ib.,  s.  50). 

Limitation  of  Prosecutions.  —  Prosecutions  must  be 
commenced  within  six  months  from  the  date  of  the  offence 
{ib.,  s.  51). 

Stay. — The  council  may  stay  proceedings  in  prosecutions 
where  deemed  expedient  {ib.,  s.  52). 

Prosecutor. — Any  person  may  be  prosecutor  or  complain- 
ant {ib.,  s.  53). 

Definition. — ''Legallj^  qualified  medical  practitioner"  or 
" duly  qualified  medical  practitioner,"  or  any  other  words  im- 
plying legal  recognition  as  a  medical  practitioner  or  member  of 
the  medical  profession,  when  used  in  any  law  or  ordinance, 
mean  a  person  registered  under  this  ordinance  {ib.,  s.  55). 

Homceopathists. — Homoeopathic  physicians  may  be  regis- 
tered under  this  ordinance  on  complying  with  the  terms  of  sec. 
34  {ib.,  s.  58). 

Fees. — To  the  council  from  each  member  annually  as  the 
council  may  determine,  not  more  than  $2  and  not  less  than  $1 
{ib.,  s.  35). 

To  the  registrar,  for  registration,  $50  {ib.,  s.  56,  as  substi- 
tuted by  Ord.  24,  1892,  s.  3). 

Nova  Scotia. 

Medical  Board. — There  is  a  provincial  medical  board  con- 
sisting of  thirteen  regular  qualified  medical  practitioners  of  not 
less  than  seven  years'  standing,  seven  nominated  and  appointed 
by  the  governor  in  council,  and  six  by  the  Nova  Scotia  Medical 
Society  (R.  S.,  5th  ser.,  c.  24,  s.  1). 

The  board  appoints  a  secretary  who  is  the  registrar  of  the 
board  {ib.,  s.  3,  4). 

Register,  Evidence. — The  registrar  is  required  before  the 
1st  of  August  each  year  to  cause  to  be  printed  and  published 
in  the  Royal  Gazette  of  the  province,  and  in  such  other 
manner  as  the  board  shall  appoint,  a  correct  register  of  the 
names  and  residences  and  medical  titles,  diplomas,  and  qualifica- 
tions conferred  by  any  college  or  body,  with  the  dates  thereof 
of  all  persons  appearing  on   the  register  as  existing  on  June 


NORTHWEST   TERRITORIES — NOVA   SCOTIA.  263 

30th,  Such  register  is  called  "The  Medical  Register,"  and  a 
copy  thereof  for  the  time  being,  purporting  to  be  so  printed 
and  published,  is  xjrima  facie  evidence  that  the  persons 
specified  are  registered  according  to  this  chapter.  The  absence 
of  a  name  &'om  such  copy  is  prima  facie  evidence  that  such 
person  is  not  so  registered.  In  the  case  of  a  person  whose 
name  does  not  appear  in  such  copy,  a  certified  copy,  under  the 
hand  of  the  registrar,  of  the  entry  of  his  name  on  the  register 
is  evidence  that  such  person  is  registered  under  the  provisions 
of  this  chapter  {ib.,  s.  5). 

Students. — ISTo  person  can  begin  or  enter  on  the  study  of 
physic,  surgery,  or  midwifery,  for  the  purpose  of  qualifying 
himself  to  practise  in  the  province,  unless  he  shall  have  obtained 
from  the  provincial  medical  board  a  certificate  that  he  has  satis- 
factorily passed  a  matriculation  examination  in  the  subjects 
specified  in  the  chapter  {ib.,  s.  6). 

The  chapter  prescribes  the  prerequisites  to  admission  to 
preliminary  examinations  (ib.,  s.  7,  12). 

Qualification. — Subject  to  the  exceptions  hereinafter,  no 
person  can  lawfully  practise  physic,  surger}^,  or  midwifery  unless 
his  name  be  registered  and  unless  he  shall  have  received  from 
the  provincial  medical  board  a  license  to  practise  (ib.,  s.  8). 

No  person  is  entitled  to  be  registered  or  to  receive  a  license 
to  practise  unless  he  satisfy  the  board  that  he  has  passed  the 
matriculation  or  preliminary  examination;  that  after  passing 
such  examination  he  has  followed  his  studies  during  a  period 
not  less  than  four  years  (one  of  which  ma}^  be  under  the  direc- 
tion of  one  or  more  general  practitioners  duly  licensed) ;  that 
during  such  four  years  he  has  attended  at  some  university, 
college,  or  incorporated  school  of  medicine  in  good  standing, 
courses  of  lectures  amounting  together  to  not  less  than  twelve 
months  on  general  anatomy,  on  practical  anatomy,  on  surger}^ 
on  the  practice  of  medicine,  on  midwifery,  on  chemistr}-,  on 
materia  medica  and  pharmacy,  and  on  the  institutes  of  med- 
icine or  physiology,  and  one  three-months'  course  of  medical 
jurisprudence;  that  he  has  attended  the  general  practice  of  a 
hospital  in  which  are  not  less  than  fifty  beds  under  the  charge 
of  not  less  than  two  physicians  or  surgeons,  for  a  period  of  not 
less  than  one  year  or  two  periods  of  not  less  than  six  months 
each ;  that  he  has  also  attended  two  three-months'  courses  or 


264  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

one  six-months'  course  of  clinical  medicine,  and  the  same  of 
clinic;al  surgery ;  that  he  has,  after  an  examination  in  the  sub- 
jects of  the  course,  obtained  a  degree  or  diploma  from  sucli 
university,  college,  or  incorporated  medical  school,  or,  for  want 
of  such  degree  or  diploma,  that  he  has  satisfactorily  passed  an 
examination  in  the  various  branches  hereinbefore  specified  before 
examiners  to  be  appointed  by  the  provincial  medical  board; 
that  he  is  not  less  than  twenty-one  years  of  age ;  and  that  he 
has  paid  the  registrar  twenty  dollars. 

The  provincial  medical  board  has  power,  subject  to  the 
approval  of  the  governor  in  council,  to  make  such  alterations 
in  the  foregoing  curriculum  as  may  from  time  to  time  be  re- 
quired {ib.,  s.  9). 

The  last  preceding  section  does  not  apply  to  any  person  in  ac- 
tual practice  duly  registered  under  chap.  56  of  Revised  Statutes, 
3d  series ;  such  persons  are  entitled  to  be  registered  and  receive 
a  license  to  practise  under  this  chapter  without  fee.  Notwith- 
standing such  section,  any  person  on  producing  to  the  said 
board  conclusive  evidence  that  he  has  passed  a  matriculation 
or  preliminary  examination  such  as  is  required  for  persons  be- 
ginning their  medical  studies  in  Nova  Scotia;  that  he  has, 
before  graduating  or  taking  a  diploma,  studied  for  at  least  four 
years  in  the  manner  provided  in  sec.  9  or  pursued  what  the 
board  deem  an  equivalent  course  of  stud}",  and  has  passed  a 
final  examination  in  the  subjects  of  such  course ;  or,  for  the 
want  of  any  of  such  requirements,  shall  have  fulfilled  such  con- 
ditions as  the  board  may  determine  and  shall  pay  a  fee  of 
twenty  dollars,  shall  be  entitled  to  be  registered  and  to  receive 
a  license  to  practise  {ib.,  s.  10). 

Powers  of  Board. — The  said  board  among  other  powers 
has  the  power  to  examine  all  degrees,  diplomas,  licenses,  and 
other  credentials  presented  or  given  in  evidence  for  the  purpose 
of  entitling  the  owner  to  practise  in  Nova  Scotia;  and  to 
oblige  the  owner  to  attest  on  oath,  or  by  affidavit,  that  he  is 
the  person  whose  na.me  is  mentioned  therein,  and  that  he 
became  possessed  thereof  honesth" ;  to  cause  every  member  of 
the  profession  practising  in  Nova  Scotia  to  enregister  his 
name,  age,  place  of  residence,  place  of  nativity,  date  of  license 
or  diploma,  and  the  place  where  he  obtained  it,  in  the  regis- 
ter of  the  board ;  to  appoint  medical  examiners  to  hold  final  ex- 


NOVA   SCOTIA.  265 

aminations,  such  examiners  to  be  regular  qualified  practitioners 
of  not  less  than  five  years'  professional  standing,  and  three 
years'  residence  in  the  province  (ib.,  s.  12). 

Register. — The  registrar  is  required  to  keep  his  register 
correct,  and  to  erase  the  names  of  all  registered  persons  who 
shall  have  died,  left  the  province  without  an}^  intention  of  re- 
turning, or  ceased  to  practise  for  five  years,  and  to  make  from 
time  to  time  the  necessary  alterations  in  the  addresses  or  quali- 
fications of  persons  registered.  A  name  erased  is  required  to 
be  restored  by  the  order  of  the  board  upon  sufficient  cause  duly 
shown  {lb.,  s.  15). 

Neglect  to  Register. — Persons  entitled  to  register  and 
neglecting  or  omitting  to  register  are  not  entitled  to  any  of  the 
rights  or  privileges  conferred  so  long  as  the  neglect  or  omission 
shall  continue  {ib.,  s.  16). 

Theories  of  Medicine  or  Surgery, — No  person  shall  be 
refused  registration  or  a  license  on  account  of  the  adoption 
or  the  refusal  to  adopt  the  practice  of  any  particular  theory  of 
medicine  or  surgery.  In  case  of  such  refusal  the  party  aggrieved 
has  the  right  to  appeal  to  the  governor  in  council,  who,  on  due 
cause  shown,  is  required  to  issue  an  order  to  the  board  to  register 
the  name  of  such  person  and  to  grant  him  a  license  {ib.,  s.  17). 

Powers  of  Registrar. — No  qualification  is  entered  unless 
the  registrar  is  satisfied  by  proper  evidence  that  the  person 
claiming  is  entitled  to  it,  and  anj^  appeal  from  the  decision  of 
the  registrar  may  be  decided  by  the  board,  and  any  eutr}' 
proving  to  the  satisfaction  of  the  board  to  have  been  fraudulently'' 
or  incorrectly  made  may  be  erased  from  the  register  by  order 
in  writing  of  the  board  {ib.,  s.  18). 

Forfeiture  of  Rights. — A  medical  practitioner  convicted 
of  felony  or,  after  due  inquirj^,  judged  by  the  board  to  have 
been  guilt}^  of  infamous  conduct  in  any  professional  respect, 
thereby  forfeits  his  right  to  registration,  and  if  registered  his 
name  shall,  by  the  direction  of  the  board,  be  erased  from  the 
register  {ib.,  s.  19). 

Additional  Qualifications. — A  registered  person  maj^ 
have  a  higher  degree  or  an  additional  qualification  obtained  by 
him,  inserted  in  the  register  in  substitution  for  or  in  addition  to 
a  qualification  previously  registered,  on  the  payment  of  such 
fee  as  the  board  may  appoint  [ib.,  s.  20). 


266  SYNOPSIS   OF   LAWS — POSTE    AND    BOSTON, 

Rights  of  Registered  Persons. — Every  registered  person 
is  entitled  according  to  his  qualifications  to  practise  medicine, 
surgery,  or  midwifery,  or  either  or  any  of  them  as  the  case 
may  be,  and  to  demand  and  receive  reasonable  charges  for  pro- 
fessional aid,  advice,  and  visits  and  the  cost  of  any  medicine  or 
any  medical  or  surgical  appliances  rendered  or  supplied  by  him 
to  his  patients  (ib.,  s.  21). 

No  person  is  entitled  to  recover  such  charge  unless  he  shall 
prove  on  the  trial  that  he  is  registered  under  this  chapter. 
This  does  not  interfere  with  the  sale  by  qualified  druggists  or 
chemists  of  articles  properly  belonging  to  their  business  {ib., 
s.  22). 

Definition.  — The  words  "  legally  qualified  medical  practi- 
tioner" or  "duly  qualified  medical  practitioner,"  or  any  other 
words  importing  a  person  recognized  by  law  as  a  medical  prac- 
titioner or  a  member  of  the  medical  profession,  when  used  in 
any  act  of  the  legislature  or  legal  or  public  document  mean 
a  person  registered  under  this  chapter  {ib.,  s.  23). 

Unregistered  Persons. — No  person  shall  be  appointed  as 
a  medical  officer,  physician,  or  surgeon,  in  any  branch  of  the 
public  service,  or  in  any  hospital  or  other  charitable  institution, 
unless  he  be  registered  under  the  provisions  of  this  chapter 
{ib.,  s.  24). 

No  certificate  required  from  any  physician  or  surgeon  or  med- 
ical practitioner  is  valid  unless  the  signer  be  registered  {ib. ,  s.  25). 

Offences  and  Penalties. — For  a  person  without  regis- 
tration or  license  to  practise  physic,  surgery,  or  midwifery  for 
hire,  gain,  or  hope  of  reward,  or  wilfully  or  falsely  pretend  to 
be  a  physician,  doctor  of  medicine,  surgeon,  or  general  practi- 
tioner, or  to  take  or  use  any  name  or  description  implying  or 
calculated  to  lead  people  to  infer  that  he  is  registered,  or  to  pro- 
fess by  public  advertisement,  card,  circular,  sign,  or  other- 
wise to  practise  physic,  surgery,  or  midwifery,  or  to  give 
advice  therein  or  in  anywise  to  lead  people  to  infer  that  he  is 
qualified  to  practise  physic,  surgery,  or  midwifery,  is  punisha- 
ble with  a  forfeiture  of  820  for  each  day  that  he  so  practises  or 
leads  people  to  infer  that  he  is  practising  {ib.,  s.  26). 

On  trial  of  such  cause  the  burden  of  proof  as  to  the  license 
or  right  of  the  defendant  to  practise  physic,  surgery,  or  mid- 
wifery is  on  the  defendant  {ib.,  s.  28). 


NOVA  SCOTIA.  267 

If  a  person  wilfully  jDrocures  or  attempts  to  procure  regis- 
tration by  making  or  producing,  or  causing  to  be  made  or  pro- 
duced, a  false  or  fraudulent  representation  or  declaration,  he, 
and  all  persons  knowingly  aiding  or  assisting  therein,  are  each 
punishable  with  a  forfeiture  of  not  less  than  $100  {ib.,  s.  30). 

To  wilfully  and  falsely  pretend  to  be  or  take  or  use  any 
name  or  description  implying  registration,  is  punishable  with  a 
forfeiture  not  exceeding  $100  {ib.,  s.  31). 

Suits  under  this  chapter  are  not  to  be  begun  after  one 
year  from  the  date  of  the  offence  or  cause  of  action  (^6., 
s.  32). 

Exceptions. — This  chapter  does  not  prevent  a  competent 
female  from  practising  midwifery  in  Nova  Scotia,  except  that 
she  must  satisfy  the  board  of  her  competency,  and  obtain  a 
certificate  from  the  registrar  before  she  can  lawfully  practise 
in  the  city  of  Halifax  {ib.,  s.  33). 

Nothing  in  the  chapter  prevents  any  person  from  giving 
necessary  medical  or  surgical  aid  or  attendance  to  any  one  in 
urgent  need  of  it,  provided  such  aid  or  attendance  is  not  given 
for  hire  or  gain,  nor  the  giving  of  it  made  a  business  or  way  of 
gaining  a  livelihood  {ib.,  s.  34). 

Every  person  residing  in  the  province  and  who  shall  have 
practised  therein  prior  to  Januarj'  1st,  1850,  is  entitled  on 
proof  thereof  to  have  his  name  registered  and  receive  a  license 
to  practise  under  this  chapter  {ib.,  s.  36). 

A  person  while  employed  in  active  service  in  Her  Majesty's 
naval  or  military  service  as  a  physician  or  surgeon  may  prac- 
tise physic,  surgery,  or  midwifery  with  {sic)  registration  or 
license  {ib.,  s.  37). 

Schedule  B  of  the  chapter  prescribes  the  subjects  for  a 
matriculation  or  preliminary  examination  of  those  commencing 
the  study  of  medicine. 

Fees. — To  the  registrar,  for  registration  under  sees.  9  and 
10,  $20. 

To  the  registrar,  for  a  preliminary  examination  under  sec. 
7,  $10. 

For  registering  additional  qualifications,  such  fee  as  the 
board  may  appoint  {ib.,  s.  20). 


268  synopsis  of  laws — poste  and  boston. 

Ontario. 

College  of  Physicians,  etc. — There  is  a  corporation  styled 
"  The  College  of  Physicians  and  Surgeons  of  .Ontario"  (Rev. 
St.,  1887,  c.  148,  s.  2). 

All  persons  registered  according  to  the  provincial  acts  29 
Victoria,  c.  34,  and  37  Victoria,  c.  45,  and  amendatory  acts,  are 
members  of  said  corporation  {ib.,  s.  3);  as  well  as  all  persons 
registered  under  this  act  {ib.,  s.  4). 

Council. — There  is  a  council  of  said  college  composed  of 
representatives  chosen  from  every  university,  college,  or  body 
in  the  province  authorized  to  grant  degrees  in  medicine  and 
surgery,  and  which  establish  and  maintain  to  the  satisfaction 
of  the  College  of  Physicians  and  Surgeons  of  Ontario  a  medical 
faculty  in  connection  therewith,  with  five  members  elected  by 
the  registered  licensed  practitioners  in  homoeopathy,  and  twelve 
members  elected  from  among  and  by  the  other  registered  mem- 
bers of  the  profession  (ib.,  s.  6). 

No  teacher,  professor,  or  lecturer  of  any  such  college  or  body 
shall  hold  a  seat  in  said  council  except  as  a  representative  of 
the  college  or  body  to  which  he  belongs  {ib.,  s.  G,  subd.  2,  as 
amended  Act  1893,  c.  27,  s.  2). 

All  members  of  the  council  representing  the  colleges  or 
bodies  aforesaid  must  be  practitioners  duly  registered  {ib.,  s.  6, 
subd.  3,  as  amended  Act  1893,  c.  27,  s.  2). 

All  dulj^  registered  practitioners  are  entitled  to  vote  at  any 
election  for  members  of  the  council  {ib.,  s.  8). 

Any  member  of  the  college  may  have  his  name  transferred 
from  one  class  of  voters  to  any  other  on  presenting  to  the  reg- 
istrar a  certificate  duly  signed  by  the  member  or  members  of 
the  board  of  examiners  to  examine  candidates  on  subjects  spe- 
cified as  peculiar  to  each  school  of  medicine,  testifying  that  the 
member  so  applying  has  shown  a  sufficient  knowledge  of  the 
system  of  medicine  he  desires  to  connect  himself  with,  to  en- 
title him  to  be  admitted  to  the  class  he  desires,  and  being 
so  admitted  he  is  entitled  to  vote  in  that  class  only  (ib.,  s. 
9  [1]). 

No  member  is  entitled  to  return  to  the  class  from  which  he 
has  been  transferred  without  the  sanction  of  the  council  {ib., 
s.  9  [2]). 


ONTARIO.  269^ 

The  council  appoints  officers  including  a  registrar  {ib., 
s.  13). 

The  council  must  appoint  an  executive  committee  to  take 
cognizance  of  and  action  upon  all  matters  delegated  to  it  by  the 
council  or  which  may  require  immediate  attention  or  interfer- 
ence between  the  adjournment  of  the  council  and  its  next  meet- 
ing, and  all  such  acts  shall  be  valid  only  till  the  next  ensuing 
meeting  of  the  council  {ib.,  s.  4). 

Division  Association. — In  each  territorial  division  estab- 
lished by  the  act  there  may  be  established  a  Division  Associa- 
tion, of  which  every  member  of  the  said  college  residing  within 
the  said  territorial  division  shall  be  a  member  {ib.,  s.  15). 

Professional  Fees. — The  division  association  may  submit 
to  the  council  a  tariff  of  professional  fees  suitable  to  their  divi- 
sion, and  on  the  said  tariff  receiving  the  approval  of  the  council, 
signed  by  the  seal  of  the  college  and  the  signature  of  the  presi- 
dent, such  tariff  shall  be  held  to  be  a  scale  of  reasonable  charges 
for  the  division  or  section  of  a  division  where  the  members  of 
the  association  making  it  reside  {ib.,  s.  IG). 

Registration. — In  a  register  kept  by  the  registrar  the  coun- 
cil is  required  to  cause  to  be  entered  the  name  of  every  person 
duly  registered  and  all  persons  who  have  complied  with  the  act 
and  the  rules  and  regulations  made  b}'  the  council  respecting  the 
qualifications  of  practitioners  of  medicine,  surgerj*,  and  mid- 
wifery ;  and  those  persons  only  whose  names  are  inscribed  in  the 
register  shall  be  deemed  to  be  qualified  and  licensed  to  practise 
medicine,  surgery,  or  midwifery,  except  as  hereinafter  provided 
{ib.,  s.  21). 

The  registrar  is  required  to  keep  his  register  correct  and  to 
make  the  necessary  alterations  in  the  addresses  or  qualifications 
of  persons  registered.  And  he  may  write  to  any  registered 
person  at  his  address  on  the  register,  to  inquire  whether  he 
has  ceased  to  practise  or  has  changed  his  residence,  and  if  no 
answer  be  returned  within  six  months,  may  erase  the  name 
of  such  person;  the  name  shall  be  restored  on  compliance  with 
the  other  provisions  of  the  act  {ib.,  s.  22,  as  amended  Act  1891, 
c.  26,  s.  9). 

It  is  optional  for  the  council  to  admit  to  registration  all  such 
persons  as  are  duly  registered  in  the  medical  register  of  Great 
Britain,  or  otherwise  authorized  to  practise  medicine,  surgerj', 


270  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

and  midwifery  in  the  United  Kingdom  of  Great  Britain  and 
Ireland,  upon  such  terms  as  the  council  may  deem  expedient 
{ib.,  s.  23  [1]). 

Any  person  actually  practising  medicine,  surgery,  or  mid- 
wifery, or  any  of  them,  in  Ontario  prior  to  January  1st,  1850, 
and  who  has  attended  one  course  of  lectures  at  any  recognized 
medical  school,  on  such  proof  as  the  council  may  require,  is 
entitled  to  register  {ih.,  s.  23  [2]). 

Any  person  actually  practising  medicine,  surgery,  or  mid- 
wifery according  to  the  principles  of  homoeopathy  before 
January  1st,  1850,  and  for  the  six  years  preceding  March 
24th,  1874,  in  Ontario,  may  in  the  discretion  of  the  representa- 
tives of  the  homoeopathic  system  of  medicine  be  registered 
{ih.,  s.  23  [3]). 

Ax\y  person  who  possesses  any  of  the  qualifications  described 
in  Schedule  B,  dated  prior  to  July  23d,  1870,  on  the  payment 
of  the  fee,  is  entitled  to  register  on  producing  to  the  registrar 
the  document  conferring  or  evidencing  his  qualification  or  qual- 
ifications, or  on  transmitting  by  post  to  the  registrar  informa- 
tion of  his  name  and  address  and  evidence  of  the  qualification 
or  qualifications  in  respect  whereof  he  wishes  to  be  registered, 
and  of  the  time  or  times  at  which  the  same  was  or  were  at- 
tained. No  one  registered  under  the  acts  mentioned  in  sec.  3 
is  liable  to  pay  for  registration  (i6.,  s.  24). 

Every  person  wishing  to  be  registered,  and  not  possessed 
before  July  23d,  1870,  of  one  of  the  qualifications  in  Schedule 
B,  must  present  himself  for  examination  as  to  his  knowledge 
and  skill  for  the  efiicient  practice  of  his  profession  before  the 
board  of  examiners  mentioned  in  sec.  28,  and  upon  passing 
the  examination  ^required  and  proving  to  the  satisfaction  of  the 
board  of  examiners  that  he  has  complied  with  the  rules  and 
regulations  of  the  council,  and  on  payment  of  such  fees  as  the 
council  may  establish,  he  shall  be  entitled  to  register  and  in 
virtue  of  his  registration  to  practise  medicine,  surgery,  and 
midwifery  {ih.,  s.  25). 

When  it  appears  that  there  has  been  established  a  central 
examining  board  similar  to  that  constituted  by  this  act,  or  an 
institution  duly  recognized  by  the  legislature  of  any  of  the 
provinces  of  the  Dominion  of  Canada  as  the  sole  examining 
body  for  the  purpose  of  granting  certificates  of  qualification, 


ONTARIO.  271 

and  wherein  the  curricuhim  is  equal  to  that  established  in 
Ontario,  the  holder  of  such  certificate  shall,  upon  due  proof,  be 
entitled  to  registration  by  the  council  of  Ontario  if  the  same 
privilege  is  accorded  by  such  examining  board  or  institution  to 
those  holding  certificates  of  Ontario  {ib.,  s.  2G^. 

Board  of  Examiners. — The  council  is  required  at  its 
annual  meeting  to  elect  a  board  of  examiners  whose  duty  it  is 
to  examine  at  least  once  in  each  year  all  candidates  for  registra- 
tion in  accordance  with  the  by-laws,  rules,  and  regulations  of 
the  council;  such  examinations  are  to  be  held  at  Toronto  or 
Kingston  at  such  times  and  in  such  manner  as  the  council  may 
by  by-laws  direct  {ib.,  s.  28). 

The  board  of  examiners  is  composed  of  one  member  from 
each  existing  teaching  body  enumerated  in  sec.  6  and  one  from 
every  other  school  of  medicine  organized  in  connection  with  any 
university  or  college  empowered  by  law  to  grant  medical  or 
surgical  diplomas  and  not  less  than  six  members  chosen  from 
the  members  of  the  College  of  Physicians  and  Surgeons  of 
Ontario  unconnected  with  any  such  teaching  body  {ib.,  s.  29, 
as  amended  Act  1893,  c.  27,  s.  5). 

HOMCEOPATHISTS. — Every  candidate  who,  at  the  time  of  the 
examination,  signifies  his  wish  to  be  registered  as  a  homoeopathic 
practitioner  shall  not  be  required  to  pass  an  examination  in 
materia  medica  or  therapeutics,  or  the  theory  or  practice  of 
physic  or  surgery  or  midwifery  except  the  operative  parts 
thereof,  before  any  examiners  other  than  those  approved  of  by 
the  representatives  in  the  council  of  the  homoeopathic  S5^stem 
{ib.,  s.  30). 

Duties  of  Council. — The  council  is  required  to  make 
orders,  regulations,  or  by-laws  for  regulating  the  register  and 
fees  for  registration  and  for  the  guidance  of  the  board  of  ex- 
aminers, and  may  prescribe  the  subjects  and  modes  of  examina- 
tion and  the  time  and  place  of  holding  the  same,  and  may  make 
all  such  rules  and  regulations  for  examination  not  contrary  to 
the  act  as  they  deem  expedient  and  necessary  {ib.,  s.  31). 

Additional  Qualification. — Every  person  registered  who 
obtains  a  higher  degree  or  other  qualification  is,  on  the  pay- 
ment of  the  fee,  entitled  to  have  it  inscribed  in  the  register  in 
substitution  for  or  in  addition  to  the  qualifications  previously 
registered  {ib.,  s.  32). 


272  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

Powers  op  Registrar. — No  qualification  is  to  be  entered 
on  the  register  unless  the  registrar  be  satisfied  by  proper  evi- 
dence that  the  person  claiming  it  is  entitled  to  it.  Appeal 
from  the  decision  of  the  registrar  may  be  decided  by  the 
council;  any  eniry  proved  to  the  satisfaction  of  the  council  to 
have  been  fraudulently  or  incorrectly  made  may  be  erased  from 
the  register  by  order  of  the  council  in  writing  {ib.,  s.  33  [1]). 

If  the  registrar  be  dissatisfied  with  the  evidence  adduced  by 
a  person  claiming  to  be  registered,  he  has  power,  subject  to  ap- 
peal to  the  council,  to  refuse  registration  until  such  evidence  is 
furnished,  duly  attested  b}^  oath  or  affidavit  before  a  judge  of 
the  county  court  of  any  county  {ib.,  s.  33  [2]). 

Erasure  and  Restoration  of  Name. — A  practitioner  is 
liable  to  have  his  name  erased  from  the  register  where  he  has 
been  convicted  before  or  after  registration  of  an  offence  which, 
if  committed  in  Canada,  would  be  a  felony  or  misdemeanor,  or 
where  he  has  been  guilty  of  any  infamous  or  disgraceful  con- 
duct in  a  professional  respect  {ib.,  s.  34  [1]). 

The  council  may,  and  on  the  application  of  any  four  regis- 
tered medical  practitioners  must,  cause  inquiry  to  be  made  into 
the  case  of  a  person  alleged  to  be  liable  to  have  his  name 
erased  under  this  section,  and  on  proof  of  such  conviction  or 
conduct  shall  cause  his  name  to  be  erased  from  the  register. 
The  name  of  a  person  shall  not  be  erased  on  account  of  his 
adopting  or  refraining  from  the  practice  of  any  particular 
theory  of  medicine  or  surgery;  nor  on  account  of  a  conviction 
for  a  political  offence  out  of  Her  Majesty's  dominions,  nor  of 
conviction  for  an  offence  which  ought  not  either  from  its  trivial 
nature  or  its  circumstances  to  disqualify  a  person  from  prac- 
tising medicine  or  surgery  {ib.,  s.  34  ['i]). 

The  council  may  order  to  be  paid  out  of  any  funds  at  their 
disposal  such  costs  as  thej^  may  deem  just  to  any  person  against 
whom  any  complaint  has  been  made,  which,  when  finally  deter- 
mined, is  found  to  have  been  frivolous  and  vexatious  {ib.,  s.  34 

[3]). 

When  the  council  direct  the  erasure  of  any  name  or  entry, 
it  shall  not  be  again  entered  except  by  direction  of  the  council 
or  any  of  the  divisions  of  the  high  court  of  justice  {ib.,  s.  35 
[1],  as  amended  Act  1891,  c.  26,  s.  3). 

If  the  council  think  fit,  thej'  may  direct  the  registrar  to 


ONTARIO.  273 

restore  anj^  name  or  entry  erased,  without  fee,  or  on  payment 
of  such  fee  not  exceeding  the  regular  fee  as  the  council  may  fix 
{ib.,  s.  35  [2]). 

The  council  is  required  to  ascertain  facts,  in  the  exercise  of 
its  powers  of  erasing  and  restoring,  by  a  committee  of  their  own 
body  of  not  more  than  five,  and  a  written  report  of  the  com- 
mittee may  be  acted  on  by  the  council  {ib.,  s.  3G  [1],  as 
amended  Act  1891,  c.  26,  s.  4). 

At  least  two  weeks'  notice  of  the  first  meeting  of  the  com- 
mittee for  ascertaining  the  facts  of  any  case  must  be  served  on 
a  person  whose  conduct  is  subject  to  inquiry,  and  such  notice 
must  embody  a  copy  of  the  charges  or  a  statement  of  the  sub- 
ject-matter of  the  inquiry,  and  specify  the  time  and  place  of 
meeting.  The  testimony  is  under  oath,  and  subject  to  cross-ex- 
amination and  the  full  right  to  call  evidence  in  defence  and 
reply.  In  the  event  of  the  non-attendance  of  such  person  the 
committee,  on  the  proof  of  personal  service  of  the  notice,  maj' 
proceed  with  the  inquiry  in  his  absence  and  without  further 
notice  {ib.,  s.  36  [5]). 

No  action  can  be  brought  against  the  council  or  committee 
for  anything  done  bona  fide  under  this  act  notwithstanding 
want  of  form  in  the  proceedings.  Any  person  whose  name  has 
been  ordered  erased  may  appeal  from  the  decision  of  the  coun- 
cil to  any  division  of  the  high  court  at  any  time  within  six 
months  from  the  date  of  the  order  of  erasure,  and  the  judge 
may  make  such  order  as  to  restoration,  confirmation,  or  further 
inquiries  by  the  committee  or  council  and  as  to  costs,  as  to  him 
shall  seem  right  {ib.,  s.  37,  as  amended  Act  1891,  c.  26,  s.  5). 

The  appeal  may  be  by  a  summons  served  .on  the  registrar  to 
show  cause,  and  is  founded  upon  a  copy  of  the  proceedings 
before  the  committee,  the  evidence  taken,  the  committee's 
report,  and  the  order  of  the  council  certified  by  the  registrar. 
The  registrar  is  required  to  furnish  to  an}"  person  desiring  to 
appeal  a  certified  copy  of  all  proceedings,  reports,  orders,  and 
papers  on  which  the  committee  acted,  on  paj'ment  of  five  cents 
a  folio  {ib.,  s.  38,  as  amended  Act  1891,  c.  26,  s.  6). 

The  Act  of  1891,  c.  26,  s.  7,  provides  for  procuring  the 
attendance  of  witnesses  before  the  committee,  and  for  paj^- 
ment  of  costs  by  the  person  whose  name  has  been  directed  to 

be  erased. 

18 


274  SYNOPSIS   OP  LAWS — POSTE   AND   BOSTON. 

Rights  OF  Registered  Persons. — Every  person  registered 
is  entitled  according  to  his  qualifications  to  practise  medicine, 
surgery,  or  midwifery,  or  any  of  them,  as  the  case  may  be, 
and  to  demand  and  recover  with  full  costs  reasonable  charges 
for  professional  aid,  advice,  and  visits  and  the  cost  of  any 
medicine  or  other  medical  or  surgical  appliances  rendered  or 
supplied  by  him  to  his  patient  (?7>.,  s.  39). 

Limitations. — One  year  after  the  termination  of  professional 
services  is  established  as  a  period  of  limitations  to  an  action  for 
negligence  or  malpractice  by  reason  thereof  against  duly  regis- 
tered members  of  said  college  (^7>.,  s.  40). 

Evidence. — The  register  is  required  to  be  printed  and 
published,  and  a  copy  thereof  purporting  to  be  so  printed  and 
published  isprima  facie  evidence  that  the  persons  specified  are 
registered;  and,  subject  to  the  provisions  of  subsection  2  of  this 
section,  the  absence  of  the  name  of  any  person  from  such  copy 
shall  be  prima  facie  evidence  that  such  person  is  not  regis- 
tered {ib.,  s.  41  [1]). 

In  case  of  the  name  of  a  person  not  appearing  in  such  copy, 
a  certified  copy,  under  the  hand  of  the  registrar,  of  the  entry 
of  the  name  on  the  register  is  evidence  that  such  person  is 
registered  {ib.,  s.  41  [2]). 

x4.nnual.  Certificate  of  Registration. — Every  regis- 
tered medical  practitioner  is  required  to  obtain  from  the  reg- 
istrar annually,  before  December  31st,  a  certificate  under  seal 
of  the  college  that  he  is  a  duly  registered  medical  practitioner 
(Act  1891,  c.  26,  s.  8). 

On  payment  of  all  fees  and  dues  payable  by  such  practitioner 
to  the  college,  the  registrar  is  required  to  write  his  name  and 
the  date  on  the  margin  of  the  certificate,  and  the  certificate  is 
deemed  to  be  issued  only  from  such  date;  any  fees  properly 
charged  during  the  time  in  which  a  name  was  erased  from  the 
register  are  legally  recoverable  on  production  of  the  certificate 
of  registration  at  time  of  suit  (ib.). 

No  certificate  is  issued  to  any  practitioner  indebted  to  the 
college,  nor  until  the  annual  fee  for  the  certificate  prescribed  by 
the  statute  and  the  by-laws  of  the  college  is  paid  (ib.). 

If  a  practitioner  omits  to  take  out  such  certificate,  he  shall 
not  be  entitled  thereto  until  he  pays  the  certificate  fee,  and  any 
other  fees  or  dues  which  he  owes  the  college  (ib.). 


ONTARIO.  275 

After  twelve  months'  default  in  taking  out  such  certificate, 
and  two  months'  notice  of  default  b}-  registered  letter  to  the  reg- 
istered address  of  the  defaulter,  if  payment  is  not  made,  the 
registrar  is  required  to  erase  his  name  and  the  provisions  as  to 
unregistered  practitioners  forthwith  applj"  (ib.). 

Such  practitioner  may,  unless  otherwise  disqualified,  obtain 
re-registration  and  re-instatement  to  full  privileges  b}"  appljing 
to  the  registrar  and  paying  up  the  fees  and  dues  and  taking  out 
his  certificate  (I'b.). 

Neglect  to  Register. — Those  entitled  to  register  and 
neglecting  so  to  do  are  not  entitled  to  any  rights  or  privileges 
conferred  b}'  registration,  and  are  liable  to  all  the  penalties 
against  unqualified  or  unregistered  practitioners  (Rev.  St., 
1887,  c.  148,  s.  42). 

Fraudulent  Registration. — If  a  person  procures  registra- 
tion by  means  of  false  or  fraudulent  representations  it  is  lawful 
for  the  registrar,  on  a  receipt  of  sufficient  evidence  of  such 
falsity  or  fraud,  to  represent  the  matter  to  the  council,  and  on 
the  written  order  of  the  president,  attested  by  the  seal  of  the 
college,  to  erase  his  name  from  the  register  and  publish  the  fact 
and  cause  of  erasure  in  the  Ontario  Gazette  ;  and  after  such 
notice  such  person  ceases  to  be  a  member  of  said  college  and  to 
enjoy  the  privileges  conferred  by  registration  without  the  ex- 
press sanction  of  the  council  {ib.,  s.  44  [1]). 

Offences  and  Penalties. — Wilfully  procuring  or  attempt- 
ing to  procure  registration  by  false  or  fraudulent  representations 
is  punishable  with  a  penalty  not  exceeding  $100.  Knowingly 
aiding  and  assisting  therein  is  punishable  with  a  penalty  of 
from  820  to  $50  for  each  offence  (ib.,  s.  44  [2]). 

Practising  without  registration  for  hire,  gain,  or  hope  of 
reward  is  punishable  with  a  penalty  of  from  $25  to  $100  (ib., 
s.  45). 

A  person  wilfully  or  falsely  pretending  to  be  a  physician, 
doctor  of  medicine,  surgeon  or  general  practitioner,  or  assum- 
ing any  title,  addition,  or  description  other  than  that  he  actually 
possesses  and  is  legally  entitled  to,  is  punishable  with  a  penalty 
of  from  $10  to  $50  {ib.,  s.  46). 

A  person  taking  or  using  a  name,  title,  addition,  or  descrip- 
tion implying  or  calculated  to  lead  people  to  infer  that  he  is 
recognized  by  law  as  a  physician,  surgeon,  accoucheur,  or  licen- 


276  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

tiate  in  medicine,  surgery,  or  midwiferj^  is  punishable  by  a 
penalt}-  of  from  $"^5  to  $100  {ib.,  s.  47). 

Unregistered  Persons. — No  person  is  entitled  to  recover 
a  charge  for  medical  or  surgical  advice  or  attendance  or  the 
performance  of  any  operation  or  any  medicine  prescribed  or 
supplied  unless  he  produces  to  the  court  a  certificate  that  he  is 
registered;  but  this  section  does  not  extend  to  the  sale  of  drugs 
or  medicines  by  a  licensed  chemist  or  druggist  {ib.,  s.  48,  as 
amended  Act  1891,  c.  26,  s.  2). 

No  person  shall  be  appointed  as  a  medical  officer,  physician, 
or  surgeon  in  any  branch  of  the  public  service,  or  in  anj-  hos- 
pital or  other  charitable  institution  not  supported  wholly  by 
voluntary  contribution,  unless  he  be  registered  {ib.,  s.  49). 

No  certificate  required  from  any  physician,  surgeon,  or 
medical  practitioner  is  valid  unless  the  signer  be  registered 
{ib.,  s.  50). 

Costs. — The  justice  of  the  peace  having  jurisdiction  of  a 
prosecution  may  award  payment  of  costs  in  addition  to  the 
penalty,  and  in  default  of  payment  may  commit  to  the  common 
jail  for  a  period  not  exceeding  one  month  unless  the  penalty 
and  costs  are  sooner  paid  {ib.,  s.  51). 

Appeal. — Any  person  convicted  who  gives  notice  of  appeal 
must  give  satisfactory  security  for  the  amount  of  the  penalty 
and  the  costs  of  conviction  and  appeal  {ib.,  s.  52). 

Proof. — In  any  trial  under  the  act,  the  burden  of  proof  as 
to  registration  is  on  the  person  charged  {ib.,  s.  53). 

Where  proof  of  registration  is  required,  the  production  of  a 
printed  or  other  copy  of  the  register  certified  under  the  hand  of 
the  registrar  for  the  time  being  is  sufficient  evidence  of  all  per- 
sons who  are  registered  practitioners,  and  any  certificate  upon 
such  copy  purporting  to  be  signed  by  any  person  in  his  capacity 
of  registrar  is  prima  facie  evidence  that  such  person  is  regis- 
trar without  proof  of  his  signature  or  of  his  being  registrar 
{ib.,  s.  54). 

Limitations  of  Prosecutions. — Prosecutions  are  limited 
to  commence  within  one  year  from  the  date  of  the  offence  {ib., 
s.  55). 

Stay. — The  council  may,  b}'  order  signed  by  its  president 
having  the  seal  of  the  college  appended,  stay  proceedings  in 
any  prosecution  when  deemed  expedient  {ib.,  s.  56). 


ONTARIO.  277 

Prosecutor. — Any  person  maj'  be  prosecutor  or  com- 
plainant {lb.,  s.  57  [2]). 

Qualification. — Schedule  B  referred  to  in  the  act  is  as 
follows : 

1.  A  license  to  practise  physic,  surgery,  and  midwifery,  or 
either,  within  Upper  Canada  under  the  acts  of  Upper  Canada, 
50  G.,  III.,  c.  13,  and  8  G.,  IV.,  c.  3,  respectively. 

2.  A  license  or  diploma  granted  under  2  Vict.,  c.  38,  or 
under  the  Consolidated  Statutes  for  Upper,  Canada,  c.  40,  or 
any  act  amending  the  same. 

3.  A  license  or  authorization  to  practise  physic,  surgery, 
and  midwifery,  or  either,  within  Lower  Canada,  whether 
granted  under  ordinance  28  G.,  Ill-,  c.  8,  or  act  10  and  11 
Vict.,  c.  26,  and  acts  amending  the  same,  or  under  c.  71  of  the 
Consolidated  Statutes  for  Upper  Canada,  or  any  act  amending 
the  same. 

4.  A  certificate  of  qualification  to  practise  medicine,  surgery, 
and  midwifery,  or  either,  hereafter  granted  by  any  colleges  or 
bodies  named  or  referred  to  in  sec.  6. 

5.  A  medical  or  surgical  degree  or  diploma  of  any  univer- 
sity or  college  in  Her  Majesty's  dominions  or  of  such  other  uni- 
versities or  colleges  as  the  council  may  determine. 

6.  A  certificate  of  registration  under  the  Imperial  Act  21 
and  22  Vict.,  c.  90,  known  as  "The  Medical  Act,"  or  any  act 
amending  the  same, 

7.  A  commission  or  warrant  as  physician  or  surgeon  in  Her 
Majesty's  military  service. 

8.  Certificates  of  qualification  to  practise  medicine  under 
any  of  the  acts  relating  to  homoeopathy  or  the  eclectic  system 
of  medicine. 

Fees. — To  registrar,  for  transfer  under  sec.  9  (2),  $2. 

To  registrar,  for  registration  under  sec.  24,  not  more  than 
$10,  to  be  fixed  by  the  by-laws  of  council. 

To  registrar,  for  registration  under  sec.  25,  such  fees  as  the 
council  may  by  general  by-law  establish. 

To  registrar,  for  copies  under  sec.  38,  5  cents  a  folio. 

Members  are  required  to  pay  an  annual  fee  to  the  college ; 
the  amount  and  means  of  enforcing  which  are  in  the  discretion 
of  the  elected  members  of  the  council  (Act  1893,  c.  27,  s.  6). 


278  synopsis  of  laws — poste  and  boston. 

Prince  Edward  Island. 

Medical  Society. — The  members  of  the  medical  profession 
constitute  a  body  corporate  under  the  name  of  the  "  Medical 
Society  of  Prince  Edward  Island"  (Act  1892,  c.  42,  s.  1). 

Persons  registered  under  the  act  o-t  Vict.,  c.  25,  or  37  Vict., 
or  the  Prince  Edward  Island  Medical  Act  of  1890,  are  mem- 
bers of  the  society  and  entitled  to  register  under  this  act  with- 
out a  fee  {ib.,  s.  2). 

All  persons  registered  under  this  act  are  members  of  the  said 
society  {ib.,  s.  3). 

Registration. — There  is  a  council  of  said  society,  composed 
of  seven  members  of  the  society  elected  by  the  society  {ib.,  s. 
4),  which  is  required  to  appoint  a  registrar  among  other  officers 
{ib.,  s.  6);  and  to  cause  him  to  keep  a  register  of  the  name  of 
every  person  registered  under  this  act,  or  the  acts  mentioned  in 
sec.  2,  and  from  time  to  time  of  the  names  of  all  persons  who 
have  complied  with  this  act  and  the  rules  and  regulations  made 
by  the  council  respecting  the  qualifications  of  practitioners  of 
medicine,  surgery,  or  midwifery,  which  is  called  the  Prince 
Edward  Island  Medical  Register ;  and  only  those  persons  whose 
names  are  inscribed  therein  are  qualified  and  licensed  to  practise 
medicine,  surger}-,  or  midwifery,  except  as  hereinafter  provided 
{ib.,  s.  8). 

The  registrar  is  required  to  keep  his  register  correct,  and  to 
make  the  necessarj^  alterations  in  the  addresses  and  qualifica- 
tions of  persons  registered  {ib.,  s.  9). 

The  council  is  required  to  admit  to  registration,  on  the  pay- 
ment of  the  registration  fee,  all  persons  duly  registered  by  the 
medical  council  of  Great  Britain  or  otherwise  authorized  to 
practise  medicine,  surgery,  or  midwifery  in  the  United  King- 
dom of  Great  Britain  and  Ireland  {ib.,  s.  10). 

Every  person  who  holds  a  medical  or  surgical  degree  or 
diploma  dated  prior  to  January  1st,  1880,  from  any  university, 
college,  or  school  of  medicine  in  Great  Britain,  Ireland,  or 
Canada,  or  any  of  the  universities  or  colleges  in  the  United 
States  mentioned  in  Schedule  A,  is  entitled  to  register  on  pro- 
ducing to  the  registrar  such  diploma  or  satisfactory'  evidence  of 
the  qualification  in  respect  whereof  he  seeks  to  be  registered 
{ib.,  s.  11). 


PRINCE   EDWARD   ISLAND.  279 

Every  person  desirous  of  being  registered,  not  registered 
under  the  acts  mentioned  in  sec.  2,  and  who  had  not  become 
possessed  of  a  diploma  as  provided  in  sec.  11,  must,  before  being 
entitled  to  register,  be  examined  as  to  his  knowledge  and  skill 
for  the  efficient  practice  of  his  profession  before  the  medical 
council,  and  on  passing  the  examination  required  and  produc- 
ing proof  of  study  in  medicine,  surgery,  and  midwifery  four 
years,  one  of  which  may  be  with  a  registered  medical  practi- 
tioner, shall,  subject  to  the  next  section,  be  entitled  to  register 
and  by  virtue  of  such  registration  to  practise  medicine,  sur- 
gery, and  midwifery ;  provided,  the  council  may,  if  it  see  fit, 
dispense  with  the  examination  in  any  case  {ih.,  s.  12). 

No  person  commencing  the  study  of  medicine  on  or  after 
September  1st,  1892,  shall  be  entitled  to  register  unless  he  has 
passed  a  matriculation  examination  equivalent  to  that  of  the 
College  of  Surgeons  of  London,  or  shall  hold  a  license  as  a  first- 
class  teacher  in  this  province,  or  shall  have  obtained  from  tht 
council  a  certificate  that  he  has  satisfactorily  passed  a  matricu- 
lation examination  in  the  subjects  specified  in  Schedule  B. 

Any  graduate  or  student  matriculated  in  the  arts  in  anj' 
university  in  Her  Majesty's  dominions  shall  not  be  required  to 
pass  the  matriculation  examination  (z7>.,  s.  13). 

The  council  may  grant  a  license  to  practise  medicine,  sur- 
gery, or  midwifery  to  an  applicant  at  the  time  of  the  passage  of 
this  act  practising  medicine,  surgery,  or  midwifery,  or  any  of 
them,  in  Prince  Edward  Island,  on  a  preliminary  examination 
as  the  council  may  think  necessary  for  the  public  safety, 
provided  such  person  shall  have  practised  five  years  in  the  prov- 
ince, but  such  person  is  not  thereby  entitled  to  registration 
{ib.,  s.  15). 

When  there  has  been  established  an  authorized  examining 
body  or  an  institution  recognized  by  the  legislature  of  any 
other  province  of  the  Dominion  of  Canada  as  the  sole  examin- 
ing body  for  granting  certificates  of  qualification,  and  where  the 
curriculum  is  equal  to  that  appointed  by  the  medical  council 
of  Prince  Edward  Island,  the  holder  of  such  certificate  shall, 
upon  due  proof,  be  entitled  to  registration  by  the  council  of 
Prince  Edward  Island,  if  the  same  privilege  is  accorded  in 
such  other  province  to  those  registered  in  Prince  Edward  Island 
(«6.,  s.  IG). 


280  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

The  council  is  required  to  hold  examinations  at  least  every 
three  months,  if  required,  for  candidates  for  registration,  at 
such  places  and  times  and  in  the  same  manner  as  the  council 
may  direct  {ib.,  s.  18). 

Every  person  registered  who  obtains  a  higher  degree  or  other 
[qualification  shall,  on  the  payment  of  such  fees  as  the  council 
shall  appoint,  be  entitled  to  have  it  registered  in  substitution 
for  or  in  addition  to  the  qualification  previously  registered  {ib., 
3.  19). 

No  qualification  is  entered  unless  the  registrar  be  satisfied, 
by  proper  evidence,  that  the  person  claiming  is  entitled  to  reg- 
ister it.  There  is  an  appeal  to  the  council ;  any  name  proved  to 
the  council  to  have  been  fraudulently  or  incorrectly  entered 
may  be  erased  by  an  order  in  writing  of  the  council  {ib., 
s.  20). 

If  the  registrar  is  dissatisfied  with  the  evidence  he  ma}^,  sub- 
ject to  appeal  to  the  council,  refuse  registration  until  the  person 
claiming  it  has  furnished  evidence  to  the  satisfaction  of  the 
registrar,  duly  attested  by  oath  or  affidavit  before  a  notary 
public  or  justice  of  the  peace  {ib.,  s.  21), 

A  medical  practitioner  guilt}^  of  infamous  or  disgraceful 
conduct  in  a  professional  respect  is  liable  to  have  his  name 
erased,  and  if  he  apply  for  registration  the  council  may  refuse 
it  {ib.,  s.  22). 

The  registrar  may  publish  in  a  newspaper  or  newspapers  of 
Prince  Edward  Island  the  fact  that  the  name  of  such  person 
has  been  erased,  and  the  cause  of  the  erasure,  but  not  until  the 
appeal,  if  any  has  been  taken  within  the  time  allowed,  has  been 
disposed  of  {ib.,  s.  23). 

Where  the  council  refuse  to  register,  or  direct  an  erasure, 
the  entry  shall  not  be  again  made  except  by  direction  of  the 
council  or  the  order  of  the  supreme  court  or  a  judge  thereof 
{ib.,  s.  24). 

Five  days'  notice  of  the  meeting  of  the  council  for  the  hear- 
ing of  an  appeal  under  sec.  2  must  be  served  on  the  person 
charged,  embodying  a  copy  of  the  charges  or  a  statement  of  the 
inquiry  and  the  time  and  place  of  meeting  {ib.,  s.  25). 

Rights  of  Registered  Persons. — Every  person  licensed 
or  registered  under  the  act  is  entitled  according  to  his  qualifi- 
cations to  practise  medicine,  surger}',  and  midwifery,  or  anj-  of 


PRINCE   EDWARD   ISLAND.  281 

them,  as  the  case  may  be,  and  recover  with  costs  his  reasonable 
charges  for  professional  aid,  advice,  and  visits,  and  the  cost  of 
medicines  or  medical  and  surgical  appliances  rendered  or  sup- 
plied by  him  to  his  patient  {ib.,  s.  26). 

Limitations. — Twelve  months  is  established  as  the  period 
of  limitations  for  an  action  from  negligence  or  malj)ractice 
against  a  person  registered  {ib.,  s.  27). 

Evidence. — The  registrar  is  required,  under  the  direction 
of  the  council,  to  print  and  publish  once  in  two  years  a  register 
of  the  names  of  all  persons  registered,  with  the  residence  and 
medical  title,  diploma,  and  qualification  conferred  by  any  college 
or  body,  with  the  dates  thereof,  as  existing  on  the  day  of  the 
publication.  A  copy  of  such  register,  for  the  time  being,  pur- 
porting to  be  so  printed  and  published,  isj)rima  facie  evidence 
that  the  persons  specified  are  registered.  The  absence  of  a  name 
from  such  copy  is  prima  facie  evidence  that  such  person  is  not 
registered. 

In  case  a  name  does  not  appear  in  the  copy,  a  certified  copy, 
under  the  hand  of  the  registrar  of  the  council,  of  the  entry  of  a 
name  is  evidence  that  such  person  is  registered  {ib.,  s.  28). 

Fraudulent  Registration. — If  a  person  be  registered  by 
false  or  fraudulent  representations  the  registrar  ma}',  on  the 
receipt  of  sufificient  evidence  thereof,  report  the  matter  to  the 
council,  and  on  the  order  of  the  council  erase  his  name  from 
the  register  and  make  known  the  fact  and  cause  by  a  notice  in 
the  newspaper  or  newspapers  on  Prince  Edward  Island  {ib.,  s. 
29  [1]). 

Offences  and  Penalties. — Wilfully  procuring  or  attempt- 
ing to  procure  registration  by  false  or  fraudulent  representation 
is  punishable  with  a  penalty  not  exceeding  $50.  Knowingly 
aiding  and  assisting  therein  is  punishable  with  a  penalty  of 
from  $10  to  $25  for  each  ofPence  {ib.,  s.  29  [2]). 

Without  registration  or  license,  practising  for  hire  or  hope 
of  reward  or  advertising  to  give  advice  in  medicine,  surgery, 
or  midwifery  is  punishable  with  a  penalty  not  exceeding  $25 
(ib.,  s.  30). 

Wilfully  or  falsely  pretending  to  be  a  physician,  doctor  of 
medicine,  surgeon,  or  general  practitioner,  or  assuming  a  title, 
addition,  or  description  not  actually  possessed,  or  pretending  to 
be  recognized  by  law  as  a  physician,  accoucheur,  or  a  licentiate 


282  SYNOPSIS    OF   LAWS — POSTE   AND   BOSTON. 

in  medicine,  surgery,  or  midwifery,  is  punishable  with  a  penalty 
not  exceeding  $35  {ib.,  s.  31). 

Unregistered  Persons. — No  person  is  entitled  to  recover 
a  charge  for  medical  or  surgical  advice  or  attendance  or  for  the 
performance  of  a  surgical  operation  unless  registered,  licensed, 
or  otherwise  authorized  under  this  act  {ib.,  s.  32). 

No  person  is  to  be  appointed  as  a  medical  officer,  physician, 
or  surgeon  in  any  branch  of  the  public  service,  or  any  hospital 
or  other  charitable  institution  unless  registered,  {ib.,  s.  33). 

Costs. — On  prosecution,  costs  may  be  awarded  and  the 
offender  may  be  committed  to  a  common  jail  in  default  of 
pa3dng  the  penalty  and  costs,  for  not  exceeding  one  month 
{ib.,  s.  34). 

Appeal  from  Conviction. — A  person  appealing  from  con- 
viction is  required  to  give  satisfactory  security  for  the  penalty, 
costs  of  conviction,  and  appeal  before  released  from  custody  {ib., 
s.  35). 

Limitation  of  Prosecutions. — Prosecutions  are  required 
to  be  commenced  within  six  months  from  the  date  of  the  offence 
{ib.,  s.  36). 

Prosecutor. — Any  person  may  be  prosecutor  or  comj)lain- 
ant  {ib.,  s.  37). 

Appeal  from  Registrar's  Decision. — A  person  aggrieved 
by  the  decision  of  the  registrar  may  appeal  to  the  council,  and 
persons  aggrieved  by  the  decision  of  the  council  may  appeal  to 
the  supreme  court  of  the  province,  which  decision  shall  be  final. 
The  act  prescribes  the  procedure  on  apjDeal  {ib.,  s.  38,  39). 

Powers  of  Council. — The  council  may  make  by-laws  for 
carrying  out  the  act,  to  be  approved  by  the  lieutenant-governor 
in  council,  but  nothing  shall  prevent  any  registered  medical 
practitioner  from  giving  medical  treatment  or  advice  to  any 
person  by  reason  of  such  person  having  previously  engaged  the 
services  of  any  other  physician  {ib.,  s.  40). 

The  council  is  authorized  to  make  regulations  regarding  the 
holding  of  examinations  and  the  subjects  of  examinations  {ib., 
s.  41). 

Exceptions. — The  act  does  not  prevent  any  person  from 
giving  necessary  medical  or  surgical  aid  or  attendance  to  any 
one  in  urgent  need  of  it  provided  it  be  not  for  hire  or  gain,  nor 
the  giving  of  it  be  made  a  business  or  means  of  livelihood ;  nor 


PRINCE   EDWARD   ISLAND.  283 

does  it  prevent  women  from  practising  midwifery,  or  any  person 
from  practising  dentistry  or  treating  cases  of  cancer  by  external 
application,  and  charging  for  such  service  and  suing  for  and 
recovering  reasonable  charges ;  nor  does  it  prevent  a  druggist, 
apothecary,  or  storekeeper  from  suing  for  and  recovering  the 
price  of  drugs  or  chemicals  supplied  or  sold  by  him  (?'&.,  s.  42). 

The  act  does  not  prevent  a  person  not  holding  a  medical 
degree,  license,  or  diploma  from  a  university  or  college  from 
practising  medicine,  surgery,  or  midwifery  provided  he  was 
engaged  in  such  practice  in  the  province  for  five  years  imme- 
diately before  the  passage  of  the  act,  nor  from  recovering  with 
costs  his  reasonable  charges  for  professional  aid,  advice,  and 
visits  and  the  cost  of  medicine  or  other  medical  or  surgical  ap- 
pliances rendered  or  supplied  by  him  to  his  j^atients  (ib.,  s.  43). 

Appeal  on  Prosecution. — Appeal  from  the  decision  on 
prosecution  may  be  taken  to  the  supreme  court  (^6.,  s.  44). 

Schedule  A : 

Universitj^  of  Pennsylvania,  Philadelphia,  Pa. 

Jefferson  Medical  College,  Philadelphia,  Pa. 

Bellevue  Medical  College,  New  York,  N.  Y. 

University  of  New  York,  New  York,  N.  Y. 

College  of  Phj^sicians  and  Surgeons,  New  York,  N.  Y. 

Harvard  University.  c 

University  of  Michigan. 

Schedule  B  specifies  at  length  the  requirements  for  the  ex- 
amination mentioned  in  sec.  13. 

Fees. — Persons  registered  under  sec.  2  are  not  required  to 
pa}^  a  fee. 

For  registration  under  sees.  11  and  12,  not  exceeding  $30, 
to  be  fixed  by  the  society. 

To  the  council,  for  a  license  under  sec.  15,  $5. 

An  annual  fee  is  required  to  be  paid  by  members  of  the 
society,  not  more  than  $5  annually,  as  levied  by  the  council 
{ib.,  s.  17). 

For  registration  under  sec.  19,  such  fees  as  the  council  may 
appoint. 


284  synopsis  of  laws — poste  and  boston. 

Quebec. 

College  of  Physicians,  etc. — All  persons  residing  in  the 
province  authorized  to  practise  medicine,  surgery,  or  midwifery 
therein,  and  registered  under  this  law,  are  constituted  a  corpora- 
tion by  the  name  of  "  The  College  of  Physicians  and  Surgeons  of 
the  Province  of  Quebec"  (R.  S.,  1888,  art.  3,969). 

The  affairs  of  the  college  are  conducted  bj^  a  board  of  gov- 
ernors, forty  in  number,  chosen  as  provided  in  the  act  and 
known  as  the  "  Provincial  Medical  Board"  {ib.,  art.  3,972  to 
3,975). 

Qualification. — No  person  can  lawfully  practise  medicine, 
surgerj",  or  midwifery  unless  he  has  obtained  a  license  from  the 
said  board  and  unless  he  be  registered  {ib.,  art.  3,976). 

Every  person  who  obtains  a  medical  degree  or  diploma  in 
any  university  or  college  mentioned  in  art.  3,972  is  entitled  to 
such  license  without  examination  as  to  his  medical  knowledge 
or  skill,  provided  such  diploma  has  only  been  given  after  four 
years  of  medical  studj'  from  the  date  of  admission  to  study  and 
according  to  the  requirements  of  the  act;  provided,  the  said 
board  has  power  to  grant  the  same  privileges  to  holders  of 
degrees  or  diplomas  of  medicine  and  surgery  from  other  British 
colonial  or  French  universities  or  colleges  {ib.,  art.  3,977). 

The  colleges  referred  to  in  art.  3,792  are:  Laval  Univer- 
sity at  Quebec,  Laval  University  at  Montreal,  University"  of 
McGill  College,  University  of  Bishops  College,  The  Incor- 
porated School  of  Medicine  and  Surgery  of  Montreal  affiliated 
with  the  University  of  Victoria  College  or  with  any  other  British 
university.  The  privilege  above  conferred  on  holders  of  de- 
grees or  diplomas  from  British  colleges  and  universities  is  ex- 
tended to  every  person  whose  name  is  entered  upon  the  medical 
register  under  the  Imperial  Medical  Act  of  1886  (49-50  Vict., 
c.  48)  or  of  any  act  amending  the  same  {ib.,  art.  3,977  a,  as 
added  by  Act  1889,  c.  39). 

The  law  prescribes  the  preliminary  qualifications  for  admis- 
sion to  study  medicine,  surgerj',  or  midwifery  to  be  ascertained 
by  examination.  No  one  is  entitled  to  the  license  of  the  college 
on  presentation  of  a  diploma  unless  previously  admitted  to  study 
in  accordance  with  these  conditions,  or  unless  he  has  passed  an 
equivalent  preliminarj^  examination  before  a  college,  school  or 


QUEBEC.  285 

board  authorized  by  law  to  requite  and  cause  such  preliuainary 
examinations  to  be  passed  in  Her  British  Majesty's  other  pos- 
sessions {ih.,  arts.  3,978,  3,979). 

A  candidate  for  a  license  to  practise  desiring  to  be  regis- 
tered, and  who  has  not  obtained  a  degree  or  diploma  in  medi- 
cine from  any  institution  mentioned  in  art.  3,972  {supra) 
must,  before  being  entitled  to  such  license  and  to  register,  pass 
an  examination  before  the  board  as  to  his  knowledge  and  skill 
for  the  efficient  practice  of  medicine,  surgery,  and  midwifery. 
Upon  passing  the  examination  and  proving  to  the  satisfaction 
of  the  examiners  that  he  has,  in  an  institution  for  the  teaching 
of  medicine  in  Her  Majesty's  possessions,  complied  with  the 
rules  and  regulations  made  by  the  provincial  board,  and  on  pay- 
ment of  such  fees  as  the  board  may  by  general  by-law  establish, 
such  person  shall  be  entitled  to  a  license  {ih.,  art.  3,980). 

All  persons  coming  from  any  recognized  college  outside  of 
Her  Majesty's  possessions  desirous  of  obtaining  a  license  from 
the  College  of  Physicians  and  Surgeons  of  the  province  must 
previously  pass  a  preliminar}-  examination  before  the  examiners 
appointed  by  the  board  or  establish  to  the  satisfaction  of  the 
board  that  they  have  already  passed  equivalent  examinations, 
and  they  must  moreover  follow  in  one  of  the  schools  of  medi- 
cine in  the  province  a  complete  course  (for  six  months)  of  lec- 
tures, and  such  other  course  or  courses  as  shall  be  necessary  to 
complete  the  curriculum  required  bj^  the  board.  They  may 
pass  their  professional  examination  immediately  after  their 
preliminary  examination  {ih.,  art.  3,981). 

Powers  of  Medical  Board. — The  board  of  governors  of 
the  College  of  Physicians  and  Surgeons  has  among  other  powers 
the  power  to  examine  all  credentials  and  documents  purporting 
to  entitle  the  bearer  to  a  license  to  practise  and  all  diplomas, 
degrees,  or  other  qualifications  sought  to  bo  registered,  and  to 
require  the  bearer  to  attest  on  oath,  to  be  administered  by  the 
chairman,  that  he  is  the  person  whose  name  is  mentioned 
therein,  and  that  he  became  legally  possessed  thereof ;  and  to 
register  in  the  books  of  the  college  the  name,  age,  place  of 
residence  and  birth  of  every  member  of  the  profession  practis- 
ing in  the  province,  the  date  of  his  license  and  the  place  where 
he  obtained  it  {ih.,  art.  3,982). 

The    provincial    medical  board,  among  other   powers,  has 


286  SYNOPSIS   OF   LAWS — POSTE   AND    BOSTON, 

the  power  to  make  regulations  respecting  the  tariffs  or  rates 
to  be  charged  in  towns  and  counties  for  medical,  obstetrical, 
or  surgical  advice,  or  for  attendance  or  for  the  performance  of 
any  operation  or  for  any  medicines  prescribed  or  supplied. 
The  tariff  must  be  approved  by  the  lieutenant-governor  in 
council,  and  can  only  come  into  force  six  months  after  its  pub- 
lication once  in  the  Quebec  Official  Gazette,  and  that  of  the 
order  in  council  approving  the  same.  The  tariff  does  not,  in 
case  of  suit,  obviate  the  necessity  of  proof  of  giving  the  advice, 
care,  prescriptions,  medicines,  and  other  things  therein  men- 
tioned (?6.,  art.  3,983), 

The  said  board  has  power  to  fix  the  fees  for  license  and 
registration  {ib.,  art.  3,984). 

Qualifications  of  Candidate. — The  qualifications  of  a 
candidate  for  a  license  are : 

1.  That  he  holds  a  certificate  of  study  from  a  licensed  phy- 
sician for  the  period  intervening  between  the  courses  of  lectures 
which  he  has  followed. 

2.  That  he  has  reached  the  age  of  twenty-one  years. 

3.  That  he  has  followed  his  studies  during  a  period  of  not 
less  than  four  years,  commencing  from  the  date  of  his  admission 
by  the  board  to  study  medicine. 

4.  That  during  said  four  years  he  attended  at  some  univer- 
sity, college,  or  incorporated  school  of  medicine  within  Her 
Majesty's  possessions  not  less  than  two  six-months'  courses  of 
general  or  descriptive  anatomy,  of  practical  anatomy,  of  sur- 
gery, of  the  practice  of  medicine,  of  midwifer}-,  of  chemistry, 
of  materia  medica  and  general  therapeutics,  of  the  institutions 
of  medicine  or  physiology  and  general  pathology,  of  clinical 
medicine,  and  of  clinical  surgery;  one  six-months'  course  or 
two  three-months'  courses  of  medical  jurisprudence,  one  three- 
months'  course  of  botany,  one  three-months'  course  of  hygiene, 
and  a  course  of  not  less  than  twenty-five  demonstrations  upon 
microscopic  anatomy,  physiology,  and  patholog}'. 

0.  That  he  attended  the  general  practice  of  a  hospital  in  which 
are  contained  not  less  than  fift}'  beds  under  the  charge  of  not  less 
than  two  physicians  or  surgeons,  for  not  less  than  one  and  one- 
half  years  or  three  periods  of  not  less  than  six  months  each. 

6.  That  he  has  attended  six  cases  of  labor  and  compounded 
medicines  for  six  months. 


QUEBEC.  287 

Each  six-months'  course  shall  have  consisted  of  one  hundred 
and  twenty  lectures  except  in  the  case  of  clinical  medicine, 
clinical  surgery,  and  medical  jurisprudence. 

Of  four  years'  study  required  by  this  section,  three  six- 
months'  sessions,  at  least,  must  be  passed  in  attending  upon 
lectures  at  a  university,  college,  or  incorporated  school  of  med- 
icine recognized  by  the  board. 

The  first  of  such  courses  must  have  been  attended  during 
the  session  immediately  succeeding  the  preliminary^  examina- 
tion, and  the  last  during  the  fourth  year  of  study,  and  the  can- 
didates must  undergo  an  examination  on  the  final  subjects  of 
the  curriculum  at  the  end  of  the  session  in  the  fourth  year  of 
study  {lb.,  art.  3,985). 

Members  of  College. — All  persons  obtaining  a  license  to 
practise  from  the  College  of  Physicians  and  Surgeons  of  the 
province  are  members  of  the  college,  but  are  not  eligible  for 
governors  within  four  years  from  the  date  of  their  admission 
as  members  [ib.,  art.  3,086). 

Women. — The  provincial  medical  board  has  power  to 
make  regulations  respecting  the  admission  of  women  to  the 
study  and  practice  of  midwifery.  Women  who  were  legally 
qualified  on  the  31st  of  October,  1879,  to  practise  as  midwives 
in  the  province,  while  required  to  conform  to  the  rules  of 
said  college,  retain  their  right.  Nothing  in  the  act  or  the  reg- 
ulations shall  prevent  women  in  the  country  from  practising 
midwifery  or  assisting  at  accouchements  without  being  ad- 
mitted to  the  study  or  practice  of  midwifery ;  but  they  must  ob- 
tain a  certificate  from  a  duly  licensed  phj^sician  certifying 
that  they  have  the  necessary  knowledge  {ib.,  art.  3,987). 

Register. — The  medical  board  is  required  to  cause  to  be 
kept  by  the  registrar  a  register  of  persons  duly  licensed  and  reg- 
istered, and  who  have  complied  with  the  law  and  the  regula- 
tions of  the  board,  and  those  persons  only  whose  names  are  in- 
scribed therein  are  deemed  to  be  qualified  and  licensed  (?"&., 
art.  3,988). 

The  registrar  is  required  from  time  to  time  to  make  the 
necessary  alterations  in  the  register  {ib.,  art.  3,989). 

Evidence. — The  registrar,  under  the  direction  of  the  board  of 
governors,  causes  to  be  printed,  published,  and  distributed  to  the 
members,  from  time  to  time,  a  copy,  called  2Vie  Quebec  Medical 


288  SYNOPSIS   OF   LAWS — POSTE   AND   BOSTON. 

Register,  of  the  register,  containing  names,  surnames,  resi- 
dences, medical  titles,  diplomas,  and  qualifications  conferred  by 
a  college  or  other  medical  body,  with  the  dates  of  the  same.  A 
printed  copy,  certified  under  the  hand  of  the  registrar  as  such, 
{■s,  prima  facie  evidence  that  the  persons  named  and  entered 
have  been  registered  in  accordance  with  this  law.  The  absence 
of  the  name  of  any  person  from  such  copy  is  prima  facie 
proof  that  such  person  has  not  been  lawfully  registered ;  pro- 
vided always  in  case  a  person's  name  does  not  appear  on  such 
printed  copy,  a  copy  or  extract  from  the  register  certified  by 
the  registrar  of  the  college  of  the  entry  of  such  person's  name 
on  the  register  is  proof  that  such  person  is  duly  registered  {ib., 
art.  3,990). 

A  certificate  under  the  hand  of  the  registrar  of  the  payment  of 
the  annual  contribution  of  members  of  the  college  i's,  prima  facie 
evidence  that  such  payments  have  been  made  {ih.,  art.  3,991). 

Neglect  to  Register. — A  person  entitled  to  register  who 
neglects  to  register  is  not  entitled  to  practise  medicine,  surgery, 
or  midwifery,  or  to  claim  any  of  the  rights  and  privileges  con- 
ferred, and  is  liable  for  all  penalties  imposed  for  practising 
without  registration,  saving  the  right  of  certain  members  hold- 
ing a  license  from  the  College  of  Physicians  and  Surgeons  of 
Lower  Canada  {ih.,  art.  3,992). 

Established  Practitioner. — A  person  who  has  attended 
medical  lectures  during  three  sessions  of  a  medical  school  in 
the  British  possessions,  and  who  has  actually  been  engaged  in 
the  practice  of  medicine  for  over  thirty  years  in  the  province, 
may,  on  proof  of  these  facts  to  the  satisfaction  of  the  provincial 
medical  board,  and  producing  a  certificate  signed  by  two  resi- 
dent medical  practitioners  in  the  neighborhood  where  he  has 
practised  that  he  has  succeeded  in  his  profession,  and  is  entitled 
to  the  consideration  of  the  board,  be  entitled  to  a  license  and  to 
registration  without  an  examination  {ih.,  art.  3,993). 

Unregistered  Persons. — No  person  unless  otherwise 
authorized  is  entitled  to  recover  any  charge  for  medical  or  sur- 
gical advice,  or  professional  service,  or  for  the  performance  of 
any  operation,  or  for  any  medicines  prescribed  or  supplied,  nor 
is  he  entitled  to  any  of  the  rights  or  privileges  conferred,  un- 
less he  has  registered  according  to  law  and  paid  his  annual  con- 
tribution to  the  college  {ih.,  art.  3,994). 


QUEBEC,  289 

No  certificate  required  from  any  physician  or  surgeon  or 
medical  practitioner  is  valid  unless  the  signer  is  registered  (/6., 
art.  3,995). 

Persons  Guilty  of  Felony.— Any  registered  member  of 
the  medical  profession  convicted  of  felony  forfeits  his  right 
to  registration,  and  the  medical  board  causes  his  name  to  be 
erased  from  the  register  {ib.^  art.  3,996). 

If  a  person  known  to  have  been  convicted  of  felony  presents 
himself  for  registration,  the  registrar  is  required  to  refuse  him 
registration  {ib.,  art.  3,997). 

Offences  and  Penalties. — A  person  not  entitled  to  reg- 
ister convicted  of  having  practised  in  contravention  of  this 
law,  for  reward  or  the  hope  of  reward,  is  liable  to  a  penalty 
of  $50. 

A  like  penalty  is  incurred  by  every  person  assuming  the 
title  of  doctor,  physician,  or  surgeon,  or  any  other  name  imply- 
ing that  he  is  legally  authorized  to  practise,  if  unable  to  estab- 
lish the  fact  by  legal  proof,  and  by  every  person  who  in  an  ad- 
vertisement in  a  newspaper  or  in  a  written  or  printed  circular, 
or  on  business  cards  or  on  signs,  assumes  a  designation  so  as 
to  lead  the  public  to  believe  that  he  is  duly  registered  or  quali- 
fied ;  and  by  every  person  who  offers  or  gives  his  services  as  a 
physician,  surgeon,  or  accoucheur  for  gain  or  hope  of  reward, 
if  he  be  not  duly  authorized  and  registered. 

Burden  of  Proof. — In  every  prosecution,  proof  of  registra- 
tion is  incumbent  on  the  party  prosecuted. 

"Witnesses. — Members  of  the  college  are  not  incompetent 
witnesses  by  reason  of  their  membership. 

Costs. — The  court  imposing  a  penalty  adds  costs,  and,  in 
default  of  payment  within  a  delay  which  it  fixes,  condemns  the 
defendant  to  imprisonment  in  a  common  jail  of  the  district  for 
sixty  days  (^Z>.,  art.  3,998). 

Evidence, — In  cases  where  proof  of  registration  is  re- 
quired, the  production  of  a  printed  or  other  copy  or  extract 
from  the  register,  certified  under  the  hand  of  the  registrar  of 
the  college,  is  sufficient  evidence  that  all  persons  named  therein 
are  registered  practitioners  and  any  certificate  upon  such 
proof,  or  other  copy  of  the  register  or  extract  from  such  register, 
purporting  to  be  signed  by  any  person  in  his  capacitj"  of  regis- 
trar of  the  college,  \^  prima  facie  evidence  that  such  person  is 
19 


290  SYNOPSIS   OF  LAWS — POSTE   AND   BOSTON. 

registrar  without  proof  of  the  signature  or  of  his  being  in 
fact  such  registrar  (ib.,  art.  3,999). 

HoMGEOPATHiSTS. — The  rights  of  homoeopathists  are  not 
affected  by  the  foregoing  sections  {ib.,  art.  4,002). 

The  homcBopathic  physicians  and  surgeons  of  the  province 
form  a  corporation  under  the  name  of  the  Montreal  Homoeo- 
pathic Association  {lb.,  art.  4,003). 

The  corporation  has  power  to  appoint  three  medical  grad- 
uates of  a  British  or  provincial  university  or  medical  licentiates 
of  a  British  or  provincial  college  or  board  legally  incorporated 
to  be  a  board  of  examiners,  to  examine  all  persons  who  may 
desire  to  obtain  a  license  to  practise  homoeopathic  medicine  {ib., 
art.  4,008). 

A  person  desiring  to  be  examined  touching  his  qualifications 
to  practise  according  to  the  doctrines  and  teaching  of  homoeop- 
athy shall  give  notice  in  writing  of  at  least  one  month  to  the 
secretary  or  treasurer  of  the  association,  and  show  that  he  is  not 
less  than  twenty-one  j-ears  of  age ;  has  followed  medical  studies 
for  not  less  than  four  years  under  the  care  of  one  or  more  duly 
qualified  medical  practitioners ;  has  attended  at  some  recognized 
university  or  incorporated  school  of  medicine  not  less  than  two 
six-months'  courses  of  anatomy,  physiology,  surgery,  theory 
and  practice  of  medicine,  midwifery,  chemistry,  materia 
medica,  and  therapeutics  respectively,  and  not  less  than  one 
six-months'  course  of  clinical  medicine  and  medical  jurispru- 
dence respectively,  or  their  equivalents  in  time ;  and  shall  have 
complied  with  the  regulations  of  such  university  or  incorporated 
school  of  medicine  with  regard  to  such  courses,  and  shall  have 
followed  such  other  course  or  courses  as  may  hereafter  be  con- 
sidered by  the  board  of  examiners  requisite  for  the  advancement 
of  a  medical  education. 

All  such  persons  shall,  at  a  regularlj"  appointed  time  and 
place,  be  examined  on  all  the  aforesaid  branches  by  the  board 
of  examiners  {ib.,  art.  4,009). 

If  the  board  be  satisfied  by  examination  that  a  person  is 
duly  qualified  to  practise  either  or  all  of  said  branches  of  medi- 
cine, as  taught  and  practised  by  homoeopathists,  they  shall  cer- 
tifj^  the  same  under  the  hands  and  seals  of  two  or  all  of  such 
board. 

The  lieutenant-governor,  on  receipt  of  such  certificate,  may, 


QUEBEC.  291 

if  satisfied  of  the  loyalty,  integritj^,  and  good  morals  of  the  ap- 
plicant, grant  to  him  a  license  to  practise  medicine,  surger}-, 
and  midwiferj^,  or  either  of  them,  conformably  to  the  certificate, 
and  all  such  licensees  are  entitled  to  all  the  privileges  enjoyed 
by  licentiates  of  medicine  {ib.,  art.  4,010). 

The  corporation  appoints  a  secretary  who  keeps  a  register  of 
names  of  all  persons  duly  licensed  to  practise  medicine,  surgery, 
and  midwifery,  or  either  of  them,  according  to  the  doctrines 
and  teachings  of  homoeopathy. 

Only  those  whose  names  are  inscribed  in  said,  register  are 
qualified  and  licensed  to  practise  according  to  the  doctrines  and 
teachings  of  homoeopathy  {ib.,  art.  4,015). 

The  said  secretarj^  is  required  to  make  the  necessary  altera- 
tions in  the  addresses  or  qualifications  of  the  persons  registered 
{lb.,  art.  4,016). 

Offences  and  Penalties. — A  person  practising  according 
to  the  homoeopathic  doctrines  for  reward  in  contravention  of 
this  act,  or  assuming  a' title  implying  that  a  person  is  legally 
authorized  to  practise  according  to  homoeopathic  doctrines,  if 
unable  legally  to  establish  such  authorization ;  or  by  advertise- 
ment published  in  a  newspaper  or  in  a  written  or  printed 
circular,  or  on  business  cards  or  signs,  assuming  a  designation 
to  lead  the  public  to  believe  that  he  is  duly  registered  and 
qualified  to  practise  according  to  the  doctrines  of  homoeopath}' ; 
or  offering  or  giving  his  services  as  physician,  surgeon,  or  ac- 
coucheur for  gain  or  hoj^e  of  reward,  if  not  duly  authorized 
or  registered,  is  punishable  with  a  penalty  of  $50. 

Burden  of  Proof. — In  every  prosecution,  the  proof  of 
registration  is  incumbent  on  the  party  prosecuted. 

Costs. — The  court  may  condemn  the  defendant  to  pay  $50 
in  addition  to  costs  within  a  delaj^  which  it  determines,  and  to 
imprisonment  of  sixty  days  in  a  common  jail  of  the  district  on 
default  of  payment  within  the  dela}'  {ib.,  art.  4,017). 

Witnesses. — A  member  of  the  corporation  is  not  an  incom- 
petent witness  on  account  of  his  membership  {ib.,  art.  4,018). 

Fees. — The  provincial  board  of  medical  examiners  may  es- 
tablish examination  fees  {ib.,  art.  3,981). 

Members  of  the  College  of  Physicians  and  Surgeons  of  the 
Province  of  Quebec  are  required  to  pay  an  annual  fee  of  $2 
{ib.,  art.  3,986). 


ff 


FORENSIC  MEDICINE. 

THANATOLOGICAL. 


THE 

LEGAL  STATUS  OF  THE  DEAD  BODY; 

THE  DISPOSAL  AND  OBLIGATION  TO  DISPOSE  OF  THE  SAME;  HOW 

AND  BY  WHOM  IT  MAY  BE  EXHUMED  OR  REMOVED; 

AUTOPSIES,  BY  WHOM  ORDERED;  THE  RIGHTS 

OF  RELATIVES  AND  ACCUSED  PERSONS. 

INCLUDING 

AN  APPENDIX  COxNTAINING  A  SYNOPSIS  OF  THE  STATUTES  OF  THE 

DIFFERENT  UNITED  STATES  AND  TERRITORIES 

CONCERNING  SAME. 


BY 

TRACY  C.  BECKER,  A.B.,  LL.B.,  etc., 

Counsellor  at  Law,  etc. ;  Professor  of  Civil  Law  and  Medical  Jurisprudence,  Law 
Department,  University  of  Buffalo. 


LEGAL  STATUS  OF  THE  DEAD  BODY. 

Disposal  and  Obligations  to  Dispose  of  the  Same. — 

There  is  no  right  of  property,  in  the  ordinary  sense  of  the  word, 
in  a  dead  human  body ;  but  for  the  health  and  protection  of 
society  it  is  a  rule  of  the  common  law,  and  which  has  been  con- 
firmed by  statutes  in  civilized  states  and  countries,  that  public 
duties  are  imposed  upon  public  officers,  and  private  duties  upon 
the  husband  or  wife  and  the  next  of  kin  of  the  deceased,  to  pro- 
tect the  body  fi^m  violation  and  see  that  it  is  properly  interred, 
and  to  protect  it  after  it  is  interred.  A  parent  is  bound  to  pro- 
vide Christian  burial  for  a  deceased  child,  if  he  has  the  means, 
but  if  he  has  not  the  means,  though  the  body  remains  unburie^ 
so  long  as  to  become  a  nuisance,  he  is  not  indictable  for  the 
nuisance  although  he  could  obtain  money  for  the  burial  ex- 
penses by  borrowing  it  of  the  poor-law  authorities  of  the  parish, 
for  he  is  not  bound  to  incur  a  debt.  (Reg.  v.  Vann,  2  Div.  C. 
C,  325;  15  Jur.,  1,090.)  On  the  other  hand  it  has  been  held 
in  England,  that  every  householder  in  whose  house  a  dead  body 
lies  is  bound  by  the  common  law,  if  he  has  the  means  to  do 
so,  to  inter  the  body  decently,  and  this  principle  aj^plies  where 
a  person  dies  in  the  house  of  a  parish  or  a  union.  (Reg.  v. 
Stewart,  12  A.  &  D.,  1,272.)  And  the  expense  may  be  paid 
out  of  the  effects  of  the  deceased.  (Tugwell  v.  Hayman,  3 
Camp.,  298,  and  note.) 

In  Pierce  v.  The  Proprietors  Swan  Point  Cemetery,  10  R. 
I.,  227,  s.  c,  14  Am.  Rep.,  667,  the  Court  said:  "That  there  is 
no  right  of  property  in  a  dead  body,  using  this  word  in  its 
ordinary  sense,  may  be  well  admitted,  yet  the  burial  of  the  dead 
is  a  subject  which  interests  the  feelings  of  mankind  to  a  much 
greater  degree  than  many  matters  of  actual  property.  There  is 
a  duty  imposed  by  the  universal  feelings  of  mankind  to  be  dis- 
charged by  some  one  toward  the  dead ;  a  duty,  and  we  maj''  also 
say  a  right,  to  protect  from  violation;  it  may,  therefore,  be 
considered  as  a  sort  of  quasi  property,  and  it  would  be  discred- 

297 


298  LEGAL   STATUS   OF   THE   DEAD    BODY — BECKER. 

itable  to  any  system  of  law  not  to  provide  a  remedy  in  such  a 
case;  .  .  .  but  the  person  having  charge  of  it  cannot  be  con- 
sidered as  the  owner  of  it  in  any  sense  whatever,  he  holds  it 
only  as  a  sacred  trust  for  the  benefit  of  all  who  may  from  fam- 
ily or  friendship  have  an  interest  in  it."  See  also  Wyncoop  v. 
Wyncoop,  42  Pa.  St.,  293;  4  Albany  Law  Jour.,  56;  Snyder  v. 
Snyder,  60  How.  Prac,  368;  Weld  v.  Walker,  130  Mass.,  422; 
Guthrie  v.  Weaver,  1  Mo.  Apps.,  136;  Johnson  v.  Marinus, 
18  Abb.  N.  C,  72,  and  note.' 

The  law  casts  the  duty  of  burial  of  the  wife  upon  the  hus- 
band, and  of  the  husband  upon  the  wife.  In  Secord  v.  Secord 
(cited  in  note  1  above),  the  Court  said:  "There  are  cogent  rea- 
sons connected  with  public  policy  and  the  peace  of  families, 
where  in  the  absence  of  testamentary  disposition  the  possession 
of  a  corpse  and  the  right  to  determine  its  burilil  should  follow 
the  administration  of  the  estate."  Inasmuch  as  the  husband 
has  the  first  right  to  administer  upon  the  estate  of  the  wife, 
and  the  wife  upon  the  estate  of  the  husband,  the  law  imposes 
the  correlative  duty  of  burial  upon  the  person  having  such 
right ;  and  so  it  has  been  held  that  the  husband  is  liable  for  the 
necessary  expense  of  the  decent  interment  of  his  wife  from 
whom  he  has  been  separated,  whether  the  party  incurring  the 
expense  is  an  undertaker  or  mere  volunteer.^ 

Where  the  deceased  leaves  a  will  appointing  executors,  the 
executors  have  a  right  to  the  possession  of  the  body,  and  the 
duty  of  burial  is  imposed  upon  them,  but  it  has  been  doubted 
whether  at  common  law  a  direction  by  will  concerning  the  dis- 
posal of  the  body  could  be  enforced,  and  therefore  the  right  to 
make  such  direction  has  been  conferred  by  statute  in  several 
States.' 

^  A  valuable  note  is  appended  to  ^  In  New  York  State,  section  305 

this  last  case,  citing  the  law  litera-  of  the  Penal  Code  provides  :  "A  per- 
ture  of  burial-grounds,  burials,  etc. ,  son  has  the  right  to  direct  the  man- 
and  also  giving  in  fvill  the  opinion  ner  in  which  his  body  shall  be  dis- 
of  the  Special  Term  of  the  New  York  posed  of  after  his  death  ;  and  also  to 
Supreme  Court,  in  the  case  of  Secord  dii'ect  the  manner  in  which  any 
V.  Secord,  not  elsewhere  reported.  part  of  his  body,  which  had  become 
And  see  also  The  Law  of  Burial,  4  separated  therefrom  during  his  life- 
Bradf.  ,503.  (Matter  of  Beekman  St.)       time,  shall  be  disposed  of;  and  the 

'■'Ambrose  v.  Kerreson,  IOC.  B. ,  provisions  of  this  chapter  do  not  ap- 
776 ;  Bradshaw  v.  Beard,  13  Com.  ply  to  any  case  where  a  person  has 
B.,  n.  s.,  .344;  Johnson  ».  Marinus,  given  directions  for  the  disposal  of 
18  Abb.  N.  C. ,  72;  Hewitt  v.  Bron-  his  body  or  any  part  thereof  incon- 
son,  5  Daily,  1;  Cunningham  v.  sistent  with  those  provisions."  See 
Reardon,  98  Mass.,  538.  also  Patterson  v.  Patterson,  59 N.Y., 


DISPOSAL   AND   OBLIGATIONS.  299 

And  where  a  widow  ordered  a  funeral  of  her  husband,  it 
was  held  that  she  was  liable  for  the  expense,  although  she  was 
an  infant  at  the  time,  the  Court  holding  that  the  expense  fell 
under  the  head  of  necessaries,  for  which  infants'  estates  are 
liable." 

If  there  be  no  husband  or  wife-of  the  deceased,  the  nearest 
of  kin  in  the  order  of  right  to  administration  is  charged  with 
the  duty  of  burial.'^    « 

Such  acts  as  casting  a  dead  human  body  into  a  river  with- 
out the  rites  of  sepulture  (Kanavans  Case,  1  Me.,  226);  steal- 
ing a  corpse  (2  East,  PC,  652)  or  stealing  for  dissection  a  dead 
body  of  one  executed  when  the  death  sentence  did  not  direct 
dissection  (Eex  v.  Cundick,  D.  &  R.,  n.  p.,  13),  were  indict- 
able offences  at  common  law.^ 

In  the  works  of  the  early  dramatists,  and  by  some  writers  of 
fiction,  it  has  been  stated,  or  implied,  that  the  body  of  a  de- 
ceased person  could  be  seized  and  detained  to  compel  the  pay- 
ment of  his  debts.  This  was  never  the  law.  In  Jones  v.  Ash- 
burnham,  4  East,  4G0,  it  was  held  that  to  seize  a  dead  body  on 
pretence  of  arresting  for  debt  would  be  contra  bonos  mores, 
and  an  extortion  on  the  relatives,  and  that  case  distinctly  over- 
rules any  authority  to  be  derived  from  the  case  of  Quick  v. 
Coppleton,  1  Vent.,  161,  to  the  effect  that  forbearance  to  seize 
or  hold  a  body  upon  such  a  pretence  would  afford  any  consid- 
eration for  a  promise  to  pay  a  debt.  So,  also,  where  a  jailer 
refused  to  give  up  a  body  of  a  person  who  had  died  while  a 
prisoner  in  execution  in  his  custody,  to  the  executors  of  the 
deceased,  unless  they  would  satisf}"  -certain  claims  against  the 
deceased  due  the  jailer,  the  Court  issued  a  peremptory  manda- 
mus in  the  first  instance,  commanding  that  the  body  should  be 
delivered  up  to  the  executors  (Rex  v.  Fox,  2  Q.  B,,  247).  And 
inR.  V.  Scott,  2  Q.  B,,  248,  it  was  said,  that  a  jailer  who  should 


583;  Me.  R.  S.,  ch.  13,  sec.  1  ;  Minn.  '^Secord  v.   Secord,   sv2:)ra;  Wvn- 

Gen.  Stats.,  sec.  6,220;  N.  D.  Comp.  coop  tJ.  Wyncoop,  42  Pa.   St.,   293; 

Laws,   sec.  6,549;  Oklahoma  Stats.,  Bogert  r.  Indianapolis,  13 Ind.,  135  ; 

sec.  2, 188.   See  also  Williams  r.  Wil-  Snyder  r.  Snyder.   60  How.    Prac, 

liams.  Law  Rpts.,  20  Ch.  D.,  659  ;  2  368  ;  Law  of  liurial,  4  Bradf.,  503. 

Wms.  on  Exrs. .    p.    968;  Secord  v.  M  Bishop  Crim.  Law,  sec.  506  ;  see 

Secord,  supra.  also  Roscoe's  Cr.  Ev.,  445,  446  ;  Ste- 

'  Chappel  V.  Cooper,  13  M.  &  W.,  phens'  Dig.  Crim.  L.,  sec.  292  ;  Reg. 

252.                     .  V.  Clark,  15  Cox  C.   C,  171. 


300  LEGAL   STATUS   OF   THE   DEAD    BODY— BECKER. 

attempt  to  do  so  would  be  guilty  of  misconduct  in  his  public 
character,  for  which  he  would  be  liable  to  prosecution.' 

How  and  by  Whom  the  Dead  Human  Body  may  he  Re- 
moved or  Exhumed. — Where  the  right  of  burial  has  been  ex- 
ercised, and  the  body  interred  in  its  final  resting-place,  no  per- 
son has  any  right  to  interfere  with  it  without  the  consent  of  the 
owner  of  the  grave,  or  of  the  properly  constituted  public  author- 
ities. In  Foster?;.  Dodd,  8  D.  &  E.,  842-854,  it  was  held,  that 
a  dead  body  belongs  to  no  one,  and  is,  therefore,  under  the 
protection  of  the  public.  If  it  lies  in  consecrated  ground,  eccle- 
siastical authorities  will  interpose  for  its  protection ;  but  whether 
in  ground  consecrated  or  unconsecrated,  indignities  offered  to 
the  remains  or  the  act  of  indecently  disinterring  them,  are  the 
ground  of  an  indictment." 

Even  the  purchaser  of  land  upon  which  is  located  a  burial- 
ground  may  be  enjoined  from  removing  bodies  therefrom,  if 
he  attempts  to  do  so  against  the  wishes  of  the  relatives  or  next 
of  kin  of  the  deceased.  Every  interment  is  a  concession  of 
the  privilege  which  cannot  afterward  be  repudiated,  and  the 
purchaser's  title  to  the  ground  is  fettered  with  the  right  of 
burial.^ 

On  the  other  hand,  the  right  of  the  municipal  or  state 
authorities,  with  the  consent  of  the  owner  of  the  burial  lot  or 
in  the  execution  of  the  right  of  eminent  domain,  to  remove  dead 
bodies  from  cemeteries  is  well  settled.' 

After  the  right  of  burial  has  once  been  exercised  by  the  per- 
son charged  with  the  duty  of  burial,  or  where  such  person  has 
consented  to  the  burial  by  another  person,  no  right  to  the  corpse 
remains  except  to  protect  it  from  unlawful  interference.'' 

^  Some  of  the  United  States  have  been  committed  ;  "  Earth  to  earth, 

enacted  statutes  declaring  it  to  be  a  ashes  to  ashes,  dust  to  dust." 
misdemeanor  to  attach  or  seize  un-  ^  1st  Pres.  Ch.  v.  2d  Pres.  Ch. ,  3 

der  execution  a  dead  body.     Ari-  Brewster,  372 ;  and  see  also  Pierce 

zona  Pen.     Code,    491,    etc.  ;    Cal.  v.    Proprietors  Swan  Point  Cem., 

Pen.    Code,    sec.    295;    Me.    R.    S. ,  supra. 

chap.  124,  sec.  26;  Mass.  Pub.  Stat.,  ■* Craig,   v.   1st  Pres.   Ch.,  88  Pa.  , 

chap.  207,  sec.  46;  N.  Dak.  Comp.  St.,   42;  Charleston  v.   Wentworth 

Laws,  sec  6, 563;   Oklahoma  Stat. ,  Cem.,4Strob.  (S.  Car. ) ,  306  ;  Coates 

sec.  2, 202  ;  R.  I.  Pub.  Stat. ,  sec.  3, 222.  v.  New  York  Citv,  7  Cow. ,  585  ;  Ham- 

2  So   in  Meagher    v.   Driscoll,    96  ilton  r.  New,   Albany,  30Ind.,  482; 

Am.  Dec,  759,  it  was  held  that  a  Paige  t).  Symonds.  63  N.  H. ,  17. 
dead  body  is  not  the  subject  of  prop-  '^Peters  u.  Peters,  43  N.  J.   Eq., 

erty,  and  after  burial  it  becomes  a  140  ;  Lowry  ?•.  Plitt,  11  Phila. ,  303  ; 

part  of  the  ground  to  which  it  has  Weld    v.     Walkei'      supra;    In   re 


AUTOPSIES.  301 

On  the  other  hand,  where  a  husband  did  not  freely  consent 
to  the  burial  of  his  wife  in  a  lot  owned  by  another  person,  it 
was  held  that  a  court  of  equity  might  permit  him,  after  such 
burial,  to  remove  her  body,  coffin,  and  tombstones  to  his  own 
lot,  and  restrain  any  person  from  interfering  with  such  re- 
moval.' 

In  Rhodes  v.  Brandt,  21  Hun,  N.  Y.,  1,  the  defendant 
brought  an  action  against  one  Beelard  to  recover  for  services 
rendered  by  him,  as  a  physician,  in  treating  a  child  of  Beelard's 
for  a  fracture  of  the  thigh-bone,  in  which  action  Beelard  set  up 
malpractice  on  the  part  of  the  defendant  as  a  defence.  During 
the  pendency  of  the  action  the  child  died  and  was  buried. 
Subsequently  Beelard,  the  father,  acting  under  the  advice  of 
his  counsel,  directed  and  allowed  the  plaintiff,  a  physician,  to 
cause  the  body  of  the  child  to  be  exhumed,  and  a  portion  of  the 
thigh-bone  to  be  removed,  in  order  that  it  might  be  used  in  evi- 
dence on  the  trial  of  the  question  of  malpractice.  After  the 
bone  was  removed,  the  body  was  returned  to  the  grave.  The 
defendant  thereupon  caused  the  plaintiff  to  be  arrested  for  un- 
lawfully removing  the  body  from  the  grave  contrary  to  the 
provisions  of  the  statute,  and  the  plaintiff"  sued  the  defendant 
for  malicious  prosecution.  The  Court  held  that  the  plaintiff 
had  not  removed  the  body  from  the  grave  "  for  the  purpose  of 
dissection  or  from  mere  wantonness,"  as  these  terms  were  used 
in  the  statute  (3  R.  S.,  Gth  ed.,  965),  for  violation  of  which  he 
had  been  arrested,  nor  had  he  committed  any  offence  against 
public  decency  or  the  spirit  of  the  statute.^ 

Autojjsies,  by  Whom  Ordered;  the  Rights  of  Belatives 
and  Accused  Persons. — As  shown  in  a  previous  article  in  this 
volume,  on  the  Powers  and  Duties  of  Coroners  and  Medical 
Examiners,  in  cases  of  sudden  or  suspicious  death,  it  has  been 

Downs,  14  N.  Y.  St.  Rep. ,  189  ;  Mor-  form  of  an  elaborate  maiisoleiim  and 
land -y.  Richardson,  23  Beav. ,  596;  built  above  the  surface  of  the 
s.c.  24  id.,  33;  Guthrie  r.  "Weaver,  ground,  was  not  a  "building,  erec- 
1  Mo.  App. ,  136  ;  4  Step.  Com.,  371 ;  tion  or  enclosure, "  withiu  the  mean- 
Reg.  V.  Theiss,  10  B.  &S.,  298.  ing  of  the  criminal  statutes  defining 

'  Weld  V.  Walker,  supra;  see  also  the  crime  of  burglary  in  entering  a 

Johnson  B.  Marinus,  .stipra.  "building,  erection  or  enclosure;" 

'^  See  also  Com.  v.  Slack,  19  Pick.,  and  hence  that  entering  such  a  tomb 

304;  People  V.  Fitzgerald,  105  N.  Y. ,  and  taking  therefrom  a  dead  body 

146;  Peoples.  Richards,  138  N.  Y.,  with  its  grave-clothes  and  cerements 

137.  In  this  last  case  it  was  held  that  would  not  amount  to  the  crime  of 

a  tomb,  althougl»constructedin  the  burglary. 


302  LEGAL    STATUS    OF   THE    DEAD    BODY — BECKER. 

the  law  for  nearly  a  thousand  years  that  an  inquisition  or  in- 
quest super  visum  corporis  must  be  held  by  an  officer  known 
as  a  coroner,  and  that  this  office  and  its  powers  and  duties  were 
inherited  by  this  country  as  part  of  the  English  common-law 
system  in  force  at  the  time  of  the  formation  of  the  republic  of 
the  United  States.  When  a  body  has  been  buried,  and  the 
coroner  believes  that  an  inquest  is  necessary,  he  has  power  to 
disinter  the  body  and  hold  an  inquest,  and  he  may  direct  a 
post-mortem  examination  to  be  made,  but  after  having  done  so 
he  must  cause  the  body  to  be  reinterred.  It  is  now  well  settled 
that  in  holding  such  an  inquest,  and  making  such  an  autopsy 
or  post-mortem  examination  required  by  his  official  duty,  the 
coroner  has  authority  to  employ,  and  it  is  his  duty  to  employ, 
professional  skill  and  aid,  and  his  contract  will  bind  the  county 
to  pay  a  reasonable  compensation  for  the  same.' 

As  will  be  seen  below  from  a  synopsis  of  the  statutes  relat- 
ing to  this  matter,  many  of  the  States  have  enacted  statutes 
defining  and  prescribing  the  duties  of  the  coroner  and  other 
public  officers  in  such  cases.  At  an  early  period  in  England 
(see  2  and  3  Will.  IV.,  chap.  75,  sec.  7)  it  was  enacted  by  the 
English  Parliament  that  any  executor  or  other  person  having 
lawful  possession  of  the  body  of  a  deceased  person,  and  not 
being  an  undertaker  or  other  party  entrusted  with  the  body  for 
the  purpose  only  of  interment,  might  lawfully  permit  the  body 
of  such  deceased  person  to  undergo  an  anatomical  examination, 
unless  to  the  knowledge  of  such  executor  or  other  partj^  such 
person  should  have  expressed  his  desire  during  his  life  in  writ- 
ing, or  verbally  in  the  presence  of  two  or  more  witnesses  dur- 
ing his  illness  whereof  he  died,  that  his  body  after  death  might 
not  undergo  such  examination,  or  unless  the  surviving  husband 
or  wife  or  known  relative  of  the  deceased  shall  require  the  body 
to  be  interred  without  such  examination.  By  another  section 
of  this  statute  (sec.  10),  professors  of  anatomy  and  other  persons 
duly  licensed  were  declared  not  liable  to  punishment  for  hav- 

'  County      of     Northampton     v.  Board  of  Com.  -».  Jameson,  86  Ind., 

Innes,  2  Carey   (Pa.),  156 ;  Com.  t5.  154;    Mo.    Rev.   Laws,    sec.    2,469; 

Hannan,  4  Barr.  (Pa.),  269 ;  Alleg.  No.    Car.    Laws,     1687,   chap.    2o9 ; 

Co.   r.   Watts,    3  Barr.    (Pa.),   468;  Tenu.  Code,  sec.  6,lo0;  N.  Y.  Laws 

Van  Hovenbergh  v.  Hasbrouck,  45  of  1874,   chap.    535,    sec.   2;   N.  Y. 

Barb.  (N.  Y.),  197  ;  Cosfordr.  Board  Laws,  1889,  chap.  500,  amending  see. 

Supervisors,  38  N.  Y.  St.  Rep.,  964 ;  308  of  the  Pen.  Code. 
Co.  of  Alleg.  V.  Shaw,  34  Pa.  St.,  301 ; 


AUTOPSIES.  303 

ing  in  their  possession  human  bodies  when  having  such  pos- 
session according  to  the  provisions  of  the  act. 

Section  308  of  the  New  York  Penal  Code,  subdivision  3,  as 
amended  by  chapter  500,  Laws  1889,  enacts  that  whenever  and 
so  far  as  the  husband,  wife,  or  next  of  kin  of  the  deceased,  being 
charged  by  law  with  the  duty  of  burial,  may  authorize  dissec- 
tion for  the  purpose  of  ascertaining  the  cause  of  death  and  no 
further,  the  right  exists  to  dissect  tli^  dead  human  body.  The 
same  statute  also  provides  that  whenever  any  district  attorney 
of  that  State,  in  the  discharge  of  his  official  duties,  shall  deem 
it  necessary,  he  may  exhume,  take  possession  of,  and  remove 
the  body  of  a  deceased  person,  or  any  portion  thereof,  and  sub- 
mit the  same  to  a  proper  physical  or  chemical  examination  or 
analysis,  to  ascertain  the  cause  of  death,  which  examination  or 
analysis  will  be  made  on  the  order  of  a  justice  of  the  Supreme 
Court  of  the  State,  or  the  county  judge  of  the  county  in  which 
the  dead  bodies  shall  be,  granted  on  the  application  of  the  dis- 
trict attorney,  with  or  without  notice  to  the  relatives  of  the 
deceased  person,  or  to  any  person  or  corporation  having  the 
legal  charge  of  such  body,  as  the  court  may  direct.  The  dis- 
trict attorney  shall  also  have  power  to  direct  the  sheriff,  con- 
stable, or  other  peace  officer,  and  employ  such  person  or  persons 
as  he  may  deem  necessary'  to  assist  him,  in  exhuming,  removing, 
obtaining  possession  of,  and  examining  physicallj'  or  chemically 
such  dead  body,  or  any  portion  thereof ;  the  expense  thereof  to 
be  a  county  charge  paid  by  the  county  treasurer  on  the  certifi- 
cate of  the  district  attorney. 

The  matter  of  ordering  autopsies  and  dissections  of  dead 
bodies,  or  exhuming  the  same  for  that  purpose  or  other  pur- 
poses, is  a  matter  of  so  much  public  importance  that  it  has  been 
regulated  in  nearly  all  of  the  United  States  by  statutory  enact- 
ments, which  together  with  the  other  statutes  relating  to  the 
subject-matter  of  this  article  are  hereunto  appended. 

The  author  of  this  article  is  greatly  indebted  for  assistance 
in  preparing  the  same,  and  in  compiling  these  statutes,  to  Mr. 
Amasa  J.  Parker,  Jr.,  of  the  Albany,  N.Y.,  bar. 


304  LEGAL   STATUS    OF   THE   DEAD    BODY — BECKER. 

APPENDIX. 

Statutory  Regulations  Concerning  Dead  Bodies. 

The  coroner  has  power  to  hold  inquest  and  direct  autopsy. 

Ala.,  Code,  sec.  4,801  et  seq. 

Ariz.,  Pen.  Code,  sec.  2,309  et  seq. 

Ark.,  R.  S.,  sec.  692. 

Cal.,  Pen.  Code,  sec.  1,510. 

Col.,  Mill's  Stat.,  sec.  870. 

Conn.,  Gen.  Stat.,  sees.  2,005,  2,008. 

Del.,  R.  S.,  ch.  33. 

Fla.,  R.  S.,  sees.  3,011,  3,019. 

Ga.,  Code,  sees.  590,  591,  4,101  et  seq. 

Idaho,  R.  S.,  sec.  8,377. 

111.,  S.  &  C.  Am.  Stat.,  v.  1,  606. 

Ind.,  R.  S.,  sees.  5,878,  5,879. 

Iowa,  McCl.  Am.  Code,  sec.  487. 

Kan.,  Gen.  Stat.,  sees.  1,780,  1,784. 

Ky.,  Gen.  Stat.,  ch.  25,  sees.  3,  11. 

La.,  Voorh.  Rev.  L.,  sec.  653. 

Me.,  R.  S.,  ch.  139,  sec.  1. 

Md.,  Code,  art.  22,  sees.  3,  4. 

Minn.,  Gen.  Stat.,  sec.  1,011  et  seq. 

Miss.,  Am.  Code,  sec.  816. 

Mo.,  R.  L.,  sec.  2,438  et  seq. 

Mont.,  Crim.  L.,  sees.  869,  883. 

Neb.,  Consol.  Stat.,  sec.  3,144. 

N.  H.,  Pub.  Stat.,  ch.  262,  sec.  1  et  seq. 

N.  J.,  Rev.  Stat.,  p.  170  et  seq. 

N.  C,  Code,  sec.  657. 

N.  Dak.,  Comp.  Laws,  sec.  664  et  seq. 

Ohio,  R.  L.,  sec.  1,221  et  seq. 

Oklahoma,  Stat.,  sec.  1,745  et  seq. 

Ore.,  Crim.  Code,  sec.  453  et  seq. 

Pa.,  Bright  Pen.  Digest,  1536,  sec.  37. 

R.  I.,  Pub.  Laws,  1884,  ch.  420,  sec.  17. 

S.  C,    R.  S.,  sees.  711,  2,664  et  seq. 

Tenn.,  Code,  sec.  6,139  et  seq. 

Va.,  Code,  sec.  2,928  et  seq. 

"Wash.,  Hill's  Am.  Stat.,  v.  1,  sec,  245  et  seq.. 


APPENDIX.  305 

W.  Va.,  Code,  ch.  154. 

Wis.,  S.  &  B.  Am.  Stat.,  ch.  200. 

Wyo.,  R.  S.,  sec.  1,870  et  seq. 
Medical  examiner  shall  hold  inquest  and  direct  autopsy. 

Mass.,  Pub.  Stat.,  ch.  26,  sees.  10,  11. 

R.  I.,  Pub.  Laws,  1884,  ch.  420. 
Justice  of  the  peace  shall  hold  inquest  and  direct  autops5^ 

Mich.,  How.  Am.  Stat.,  v.  2,  sec.  9,583  et  seq. 

Nev.,  Gen.  Stat.,  sec.  225  et  seq. 

N.  M.,  Comp.  L.,  sec.  443  et  seq. 

Texas,  Code  Crim.  P.,  art.  988  et  seq. 

Vt.,  Rev.  L.,  sec.  3,934  et  seq. 

Wis.,  S.  &  B.  Am.  Stat.,  ch.  200. 
And  ma}^  order  a  body  to  be  disinterred  for  the  purpose  of 
holding  such  inquisition. 

Ark.,  R.  L.,  sec.  718. 

Cal.,  Pen.  Code,  sec.  1,510. 

Del.,  R.  L.,  ch.  33. 

Ga.,  Code,  sees.  590,  591,  410  et  seq. 

Idaho,  R.  L.,  sec.  8,377. 

S.  C,  R.  S.,  sec.  2,687. 

Texas,  Code  Crim.  P.,  art.  989. 
And  when  not  claimed  by  friends  and  relatives,  to    ury  the 
body  decently,  and  when  the  property  of  deceased  is  not  suffi- 
cient to  defray  expenses,  this  may  be  done  at  public  expense. 

Cal.,  Pen.  Code,  sec.  3,094. 

Col.,  Mill's  Stat.,  sec.  882. 

Conn.,  Gen.  Stat.,  sec.  2,015. 

Idaho,  R.  L.,  sec.  2,081. 

111.,  S.  &  C.  Am.  Stat.,  v.  1,  606. 

Iowa,  McCl.  Am.  Code,  sec.  501. 

Kan.,  Gen.  Stat.,  sec.  1,792. 

Ky.,  Gen.  Stat.,  ch.  25,  sec.  6. 

La.,  Voorh.  Rev.  L.,  sec.  660. 

Me.,  R.  S.,  ch.  139,  sec.  11. 

Md.,  Code,  art.  22,  sec.  7. 

Mass.,  Laws,  1887,  ch.  310. 

Mich.,  How.  Am.  Stat.,  v.  3,  sec.  9,593. 

Minn..  Gen.  Stat.,  sec.  1,021. 

Miss.,  Am.  Code,  sees.  3,145,  3,146. 

20 


306  LEGAL   STATUS   OF   THE    DEAD    BODY — BECKER. 

Mo.,  R.  L.,  sec.  :i,45C. 

Mont.,  Gen.  Laws,  sec.  881. 

Neb.,Consol.  Stat.,  sec.  3,144. 

Nev.,  Gen.  Stat.,  sec.  2,269. 

N.  H.,  Pub.  Stat.,  ch.  262,  sec.  16. 

N.  J.,  Rev.  Stat.,  p.  170,  sec.  5. 

N.  M.,  Comp.  Laws,  sec.  447. 

N.  Dak.,  Comp.  Laws,  sec.  676. 

Ohio,  R.  L.,  sec.  1,227. 

Oklahoma,  Stat.,  sec.  1,759. 

Ore.,  Grim.  Code,  sec.  462. 

R.  I.,  Pub.  Laws,  1884,  ch.  420,  sec.  24. 

Tenn.,  Code,  sec.  6,150. 

Va.,Code,  sec.  3,946. 

Wash.,  Hill's  Am.  Stat.,  v.  1,  sec.  257. 

W.  Va.,  Code,  ch.  154,  sec.  8. 

Wis.,  S.  &  B.  Am.  Stat.,  ch.  200. 

Wyo.,  R.  S.,  sec.  1,886. 
Removal  or  disinterment  of  a  dead  body  without  authority 
of  law  or  consent  of  relatives,  for  the  purpose  of  selling  such 
body  6r  for  dissection  or  for  mere  wantonness,  is — 

(a)  A  felony. 

Cal.,  Pen.  Code,  sec.  290. 

Ga.,  Laws,  1882,  v.  2,  p.  87. 

111.,  S.  &  C.  Am.  Stat.,  v.  1,  p.  794. 

Ind.,  R.  S.,  sec.  2,166. 

Mo.,  R.  S.,  sees.  3,842,  3,845. 

Mont.,  Law^s,  1889,  p.  114. 

N.  C,  Laws,  1885,  ch.  90. 

(b)  A  misdemeanor. 

Ark.,  R.  S.,  sees.  1,902,  1,903. 
Del.,  Laws,  1883,  ch.  234. 
Kan.,  Gen.  Stat.,  sec.  2,372  et  seq. 
Md.,  Code,  art.  27,  sees.  133,  134. 
Pa.,  Bright  Pen.  Digest,  229,  sec.  11. 
Tenn.,  Code,  sees.  5,659,  5,660. 

(c)  Is  punishable  by  various  sentences. 

Ala.,  Code,  sees.  4,023,  4,028. 
Ariz.,  Pen.  Code,  sec.  491. 
Col.,  Mill's  Stat.,  sec.  1,367. 


APPENDIX.  307 

Conn.,  Gen.  Stat.,  sec.  1,880. 

Fla.,  K.  L.,  sec.  3,625. 

Iowa,  McCl.  Am.  Code,  sec.  5,328. 

Kj.,  Gen.  Stat.,  ch.  29,  art.  17,  sec.  16. 

Me.,  R.  S.,  ch.  124,  sec.  27. 

Mass.,  Pub.  Stat.,  ch.  207,  sees.  47,  48. 

Mich.,  How.  Stat.,  v.  2,  sec.  9,297. 

Miss.,  Am.  Code,  sees.  1,023,  1,024. 

Neb.,  Consol.  Stat.,  sec.  5,847. 

N.  H.,  Pub.  Stat.,  ch.  266,  sec.  7. 

N   Dak.,  Comp.  Laws,  sec.  6,559. 

Ohio,  R.  L.,  sec.  7,034. 

Oklahoma,  Stat.,  sec.  2,198. 

Ore.,  Crim.  Code,  sec.  656. 

Texas,  Pen.  Code,  art.  345. 
"Vt.,  Rev.  L.,  sees.  4,194,  4,196. 

Va.,  Code,  sec.  208. 

W.  Va.,  Code,  ch.  149,  sec.  13. 

Wis.,  S.  &  B.  Am.  Stat.,  sec.  4,593. 

Wyo.,  R.  L.,  sec.  1,029. 
(d)  A  high  misdemeanor. 

N.  J.,  Rev.  Stat.,  p.  249,  sec.  122. 
Bodies   of   criminals  executed   under   sentence,   and   those 
dying  in  jail,  poor-house,  etc.,  when  to  be  delivered  over  for 
dissection. 

Ark.,  R.  S.,  sec.  2,552. 

Cal.,  Pen.  Code,  sec.  3,094. 

Col.,  Mill's  Stat.,  sees.  1,547,  1,548,  1,204. 

Conn.,  Gen.  Stat.,  sees.  1,729,  1,732. 

Ga.,  Laws,  1887,  v.  2,  p.  87. 

111.,  S.  &  C.  Am.  Stat.,  v.  1,  869. 

111.,  Crim.  Code,  sec.  503. 

111.,  S.  &  C.  Am.  Stat.,  v.  3,  p.  867. 

Ind.,  R.  L.,  sec.  4,258  et  seq. 

Iowa,  McCl.  Am.  Code,  sec.  5,329. 

Kan.,  Gen.  Stat.,  sec.  3,758. 

Me.,  R.  S.,  ch.  13,  sec.  2. 

Me.,  Laws,  1893,  ch.  254. 

Mass.,  Laws,  1891,  ch.  185. 

Mass.,  Pub.  Stat.,  ch.  202,  sec.  8. 


308  LEGAL   STATUS   OF   THE   DEAD   BODY — BECKER. 

Mich.,  How.  Stat.,  v.  3,  sec.  2,284. 

Minn.,  Gen.  Stat.,  sec.  678. 

Mo.,  R.  S.,  sec.  6,883. 

Neb.,  Consol.  Stat.,  sees.  3,299,  3,301,  5,848. 

N.  H.,  Pub.  Stat.,  ch.  136. 

N.  J.,  Rev.  Stat.,  p.  239,  sec.  69. 

N.  C,  Laws,  1891,  ch.  129. 

N.  Dak.,  Laws,  1890,  ch.  92. 

Ohio,  R.  S.,  sec.  3,763. 

Ore.,  Hill's  Am.  Laws,  sec.  3,730  et  seq. 

Pa.,  Bright  Pen.  Dig.,  p.  94,  sec.  1  et  seq. 

Vt.,  Laws,  1884,  ch.  85. 

Va.,  Code,  ch.  80. 

Wash.,  Hill's  Am.  Stat.,  v.  1,  sec.  2,428  et  seq. 

Wash.,  S.  &  B.  Am.  Stat.,  sec.  1,437. 
Duty  of  burial,  etc. 

Ariz.,  Pen.  Code,  sec.  493. 

Cal.,  Pen.  Code,  sec.  292. 

Minn.,  Gen.  Stat.,  sec.  6,221. 

N.  Dak.,  Comp.  Laws,  sees.  6,550,  6,556. 

Oklahoma,  Stat.,  sec.  2,189. 
Concealing  birth  of  child  which,  if  born  alive,  would  be  a 
bastard,  is  punishable. 

Col.,  Mih's  Stat.,  sec.  1,195. 

Fla.,  R.  L.,  sec.  2,393. 

Mass.,  Pub.  Stat.,  ch.  207,  sec.  11. 

Mich.,  How.  Am.  Stat.,  sec.  9,284. 

Mont.,  Crim.  L.,  sec.  41. 

Neb.,  Consol.  Stat.,  sec.  5,582. 

Nev.,  Gen.  Stat.,  sec.  4,597. 

N.  H.,  Pub.  Stat.,  ch.  278,  sec.  14. 

N.  Dak.,  Comp.  L.,  sec.  6,947. 

Oklahoma,  Stat.,  sec.  2,179. 

Ore.,  Crim.  Code,  sec.  649. 

Pa.,  Bright  Pen.  Digest,  431,  sec.  158. 

R.  I.,  Pub.  Stat.,  ch.  244,  sec.  8. 

Wis.,  S.  &  B.  Am.  Stat.,  sec.  4,585. 
Is  a  misdemeanor. 

Minn.,  Gen.  Stat.,  sec.  6,210. 

N.  J.,  Rev.  Stat.,  p.  241,  sec.  83. 


ALABAMA — ARKANSAS.  309 

Is  a  felony. 

Mo.,  R.  S.,  sec.  3,479  (whether  born  dead  or  alive 

Alabama. 

Removal  of  body  wantonly  for  dissection  or  sale,  purchase 
of  a  body  unlawfully  disinterred,  violating  grave  with  intent  to 
steal  body,  etc.,  or  wantonly  mutilating  body,  is  punishable  by 
fine  or  imprisonment  (Code,  sees.  4,023,  4,028). 

Coroner,  or  in  his  absence  justice  of  the  peace,  to  hold  in- 
quest and  direct  examination  of  bodj^  by  surgeon,  etc.  (Code, 
sec.  4,801  et  seq.). 

Arizona. 

Mutilation,  etc.,  of  dead  body  is  a  felony  (Pen.  Code,  sec. 
491). 

Removal  of  a  part  of  body  unlawfully  is  punishable  (Pen. 
Code,  sec.  492). 

Duty  of  burying  body  is,  if  a  married  woman,  on  husband ; 
if  not  a  married  woman,  on  nearest  of  kin  who  is  an  adult  pos- 
sessed of  sufficient  means.  If  deceased  has  no  relatives,  on  cor- 
oner holding  inquest  or  overseers,  etc.,  of  poor  (Pen«  Code, 
sec.  493). 

Refusal  of  one  on  whom  dutj'^  of  burial  is  imposed  by  law, 
is  punishable  (Pen.  Code,  sec.  494). 

Arrest  or  attachment  of  a  dead  body  is  a  misdemeanor 
(Pen.  Code,  sec.  496  et  seq.). 

Coroner  to  hold  inquest  and  direct  autopsy  (Pen.  Code,  sec. 
2,309  et  seq.). 

Person  whose  duty  it  is  to  bury  is  entitled  to  custody  except 
where  coroner  holds  it  until  inquest  is  completed  (Pen.  Code, 
sec.  495). 

Arkansas. 

Bodies  of  persons  dying  in  alms-house,  prison,  house  of  cor- 
rection, or  jail  shall  be  surrendered  to  a  ph3^sician  for  dissection, 
etc.,  unless  the  deceased  request  to  be  buried  or  the  body  is 
claimed  by  relatives,  or  unless  deceased  died  suddenly  and  un- 
known ;  and  after  such  use  for  dissection  it  shall  be  decently 
buried  (R.  S.,  sec.  2,552). 

Removal  of  dead  body  for  the  purpose  of  dissection,  or  steal- 
ing, or  from  wantonness,  or  receiving  same  knowing  it  to  have 


310  LEGAL   STATUS   OF   THE   DEAD   BODY — BECKER. 

been  unlawfully  disinterred,  is  a  misdemeanor  (R.  S.,  sees. 
1,902,  1,903). 

Dead  bod}-  can  be  transported  out  of  county  in  which  death 
occurred  on  permit  of  State  board  of  health  (R.  S.,  sec.  480). 

Coroner  to  hold  inquest  and  direct  autopsy,  etc.  (R.  S.,  sec. 
692). 

And  may  order  a  body  to  be  disinterred  for  inquisition  (R. 

S.,  sec.  718). 

California. 

Removal,  mutilation,  or  disinterment  of  dead  body  without 
authority  of  law  is  a  felony  (Pen.  Code,  sec.  290). 

Removal  of  part  of  body  for  sale,  dissection  maliciously  or 
wantonly  is  punishable  (Pen.  Code,  sec.  291). 

Duty  of  Burial. — Of  married  woman,  on  husband ;  not  a 
married  woman,  nearest  of  kin  who  is  an  adult  with  sufficient 
means ;  where  no  relatives,  on  coroner  who  held  the  inquest  or 
overseers,  etc.,  of  poor  (Pen.  Code,  sec.  292). 

Refusal  to  bury  by  person  on  whom  duty  rests  by  law  to 
bury,  is  a  misdemeanor  and  he  is  liable  for  treble  the  expenses 
(Pen.  Code,  sec.  293). 

Custody  of  body  is  on  him  on  whom  duty  to  bury  is  imposed 
by  law,  except  where  coroner  detains  remains  for  inquest  (Pen. 
Code,  sec.  294). 

Arrest  or  attachment  of  dead  body  for  any  debt  or  demand 
is  a  misdemeanor  (Pen.  Code,  sec.  295). 

One  who  disinters  or  exhumes  a  body  without  permit  of 
board  of  health,  health  officer,  or  ma^'or,  or  transports  such  ex- 
humed remains  through  streets  of  town,  city,  etc.,  except  in  a 
sealed  coffin,  guilty  of  a  misdemeanor  (Laws,  1878,  ch.  073). 

A  sheriff,  coroner,  or  keeper  of  countj^  poor-house,  public 
hospital,  county  jail,  or  State  prison,  etc.,  must  surrender  bodies 
of  those  who  are  to  be  buried  at  public  expense,  to  any  phj'sician 
or  surgeon  for  dissection,  etc.,  unless  deceased  during  his  last 
sickness  requested  to  be  buried  or  body  is  claimed  by  relatives, 
etc.,  or  deceased  was  a  stranger  or  traveller,  died  suddenly 
(Pen.  Code,  sec.  3,091). 

Coroner  to  bury  body  when  no  other  person  takes  charge  of 
same   (Pen.  Code,  sec.  4,286). 

Coroner  to  hold  inquest,  direct  autopsy,  and  may  exhume 
(Pen.  Code,  sec.  1,510). 


COLORADO— CONNECTICUT.  311 


Colorado. 


Concealment  of  death  of  issue  which,  if  born  alive,  would 
be  a  bastard,  is  punishable  (Mill's  Stat.,  sec.  1,195). 

Body  of  criminal  executed  for  capital  offence  shall  be  deliv- 
ered to  a  physician  or  surgeon  unless  claimed  by  relative  or 
friend  (Mill's  Stat.,  sec.  1,204). 

Board  of  health,  mayor,  etc.,  or  officer,  etc.,  having  control 
of  any  alms-house,  prison,  hospital,  jail,  etc.,  shall  surrender 
bodies  to  be  buried  at  public  expense  to  any  physician  or  sur- 
geon for  dissection,  etc.,  unless  deceased  during  last  illness 
requested  to  be  buried,  or  body  is  claimed  by  relatives  or  friends, 
or  deceased  was  a  stranger  or  traveller  who  died  unknown 
(Mill's  Stat.,  sees.  1,547,  1,548). 

Non-resident  poor  person  to  be  decently  buried  (Mill's  Stat., 
sec.  3,391). 

Coroner  to  hold  inquest,  etc.,  or,  if  none,  bury  it  decently  at 
expense  of  county  (Mill's  Stat.,  sees.  870-882). 

Removal  of  body  unlawfully  for  sale,  dissection,  etc.,  pun- 
ishable (Mill's  Stat.,  sec.  1,367). 

Board  of  health  may  direct  removal  of  dead  bodies  from 
cemetery  within  a  city  (Laws,  1893,  ch.  113,  sec.  54). 

Connecticut. 

No  body  shall  be  buried  or  disinterred  or  removed  beyond 
limits  of  any  town  unless  a  permit  is  obtained,  and  where  de- 
ceased died  of  an  infectious  disease  body  shall  be  in  a  hermet- 
icallj'  sealed  case  (Gen.  Stat.,  sees.  lOG,  108,  113). 

Custody  of  remains  is  in  husband  or  wife  or  next  of  kin 
(Gen.  Stat.,  sec.  536). 

Coroner  to  hold  inquest,  etc.  (Gen.  Stat.,  sees.  2,005,  2,008). 

And  deliver  body  to  friends  or,  if  none,  to  town  authorities 
for  burial  (Gen.  Stat.,  sec.  2,015). 

Mayor,  etc.,  may  deliver  bodies  of  those  not  buried  within 
twenty-four  hours  after  death  to  medical  college  for  dissection, 
etc.,  unless  relatives  or  friends  do  not  consent,  or  deceased 
requested  to  be  buried,  or  was  a  stranger  or  traveller  (Gen. 
Stat.,  sec.  1,729). 

Bodies  of  convicts  dying  in  State  prison  and  not  having  any 


312  LEGAL   STATUS   OF   THE   DEAD    BODY — BECKER. 

known  relatives,  shall  be  delivered  to  medical  institution  of 
Yale  College  (Gen.  Stat.,  sec.  1,732). 

Body  of  one  dying  in  a  hospital  shall  not  be  examined  unless 
father,  etc.,  consent,  or  if  none,  within  forty-eight  hours  after 
death  (Gen.  Stat.,  sec.  1,735). 

Removal  of  body  from  grave  unlawfully,  or  receiving, 
secreting,  or  dissecting  same,  is  punishable  (Gen.  Stat.,  1880). 

Body  of  executed  criminal  shall  be  buried  by  sheriff  (Gen. 
Stat.,  sec.  1,G40). 

Delaware. 

Coroner  to  hold  inquest,  etc.,  or  maj^  cause  body  to  be  dis- 
interred (R.  L.,  ch.  33). 

Removal  of  body  from  grave  unlawfully,  a  misdemeanor 
(Laws,  1883,  ch.  204). 

Florida. 

Buying,  selling,  or  having  possession  for  purpose  of  buying 
or  selling,  a  dead  body  is  punishable  (R.  L.,  sec.  2,625). 

Concealing  birth  of  issue  which,  if  born  alive,  would  be  a 
bastard,  is  punishable  (R.  L.,  sec.  2,393). 

Coroner  to  hold  inquest,  etc.  (R.  L.,  sees.  3,011,  3,019). 

♦ 
Georgia. 

Coroner  to  hold  inquest  or  to  disinter  same  for  inquisition 
(Code,  sees.  590,  591,  410  et  seq.). 

Public  officers  and  their  assistants,  and  their  deputies  of 
every  county,  cit}",  town,  or  other  municipality,  or  of  every 
prison,  chain  gang,  penitentiary,  county  morgue,  public  hospi- 
tal, having  control  of  dead  body  to  be  buried  at  public  expense 
(not  dying  of  infectious  disease)  shall  deliver  same  to  medical 
college  for  dissection,  etc.,  unless  claimed  by  friends  or  relatives 
or  such  friends  or  relatives  request  same  to  be  buried,  or  unless 
deceased  was  a  stranger  or  traveller  (Laws,  1887,  vol.  2,  p.  77). 

Removal  of  body  from  grave,  etc.,  unlawfully  for  dissection 
or  sale  is  felonj^,  or  receiving  or  purchasing  it  knowing  it  to 
have  been  so  taken,  or  trafficking  in  dead  bodies,  or  having  them 
conveyed  without  the  State  for  sale,  etc.,  is  a  felony  (Laws, 
1882,  vol.  2,  p.  87). 


idaho — indiana.  313 

Idaho. 

Coroner  to  hold  inquest,  etc.,  and  may  exhume  it  for  that 
purpose  (R.  L.,  sec.  8,377). 

Coroner  to  bury  body  decently  when  not  claimed  by  rela- 
tives, etc.,  and  if  necessary,  at  expense  of  county  (R.  L.,  sec. 
2,081). 

Illinois. 

Removal  of  body  unlawfully  or  aiding  in  such  removal  is 
punishable  as  a  felony — one  to  ten  years  (S.  &  C.  Am.  Stat., 
vol.   1,  p.  794). 

Coroner  to  liuld  inquest,  etc.  (S.  &  C.  Am.  Stat.,  vol.  1,  p. 
G06). 

And  to  deliver  body  to  friends  or  bury  decently  if  no  friends 
claim  it,  if  necessary  at  county  expense  (S.  &  C.  Am.  Stat.,  vol. 
1,  p.  G0()). 

Body  of  executed  criminals  may  be  delivered  to  any  physi- 
cian or  surgeon  for  dissection  unless  friends  object  (S.  &  C. 
Am.  Stat.,  vol.  1,  p.  869;  Crim.  Code,  sec.  503). 

In  cities  and  counties  where  population  exceeds  one  hundred 
tliousand,  superintendents  of  penitentiaries,  wardens  of  poor- 
houses,  coroner,  city  undertaker,  having  body  required  to  be 
buried  at  public  expense,  may  deliver  remains  to  medical  college 
or  any  physician  or  surgeon  for  dissection,  unless  claimed  by 
relatives  (S.  &  C.  Am.  Stat.,  vol.  3,  p.  807). 

Indiana. 

RemoA'^al  of  dead  body  or  part  of  same  unlawfully  is  a  felony 
{R.  L.,  sec.  2,105). 

Concealment  of  body  or  part  thereof,  which  has  been  unlaw- 
full}"  used  for  dissection,  is  a  felony  (R.  L.,  sec.  2,107). 

Receiving  or  buying  a  bod}-  knowing  it  to  have  been  unlaw- 
fully disinterred  is  a  felony  (R.  L.,  sec.  2,1G8), 

Dead  body  of  one  dying  in  a  State,  city,  or  county  prison  or 
jail,  or  county  asjdmn  or  infirmary  or  public  hospital,  or  dead 
body  of  an  executed  criminal,  or  dead  body  of  a  vagrant,  or  one 
killed  while  committing  a  felony  or  escaping  from  prison  or 
officers,  may  be  delivered  to  the  facult}'  of  a  medical  college  in 
State  for  dissection,  etc. ,  unless  deceased  requested  to  be  buried 
or  body  is  claimed  by  next  of  kin  (R.  L.,  sec.  4,258  et  seq.). 


314  LEGAL   STATUS   OF   THE   DEAD    BODY — BECKER. 

Dissecting  or  possessing  body  for  dissection  except  as  pre- 
scribed by  law  is  a  felony  (R.  L.,  sec.  4,271). 

Coroner  to  hold  inquest,  etc.  (K.  L  ,  sees.,  5,878,  5,879). 

Iowa. 

Coroner  to  hold  inquest,  etc.  (McCl.  Am.  Code,  sec.  487). 

To  bury  body  decently  at  expense  of  county,  if  necessary,  or 
ueliver  it  to  relatives  (McCl.  Am.  Code,  sec.  501). 

Removal,  etc. ,  of  dead  body  unlawfully,  or  aiding  such  re- 
moval or  knowingly  receiving  body  so  removed,  etc.,  is  punish- 
able (McCl.  Am.  Code,  sec.  5,328). 

Coroner,  undertaker,  superintendent  of  public  asylum,  hos- 
pital, poor-house,  or  penitentiary,  may  deliver  body  to  medical 
college  or  physician  for  dissection,  etc.,  unless  relatives,  etc., 
refuse  or  deceased  desired  to  be  buried  (McCl.  Am.  Code,  sec. 
5,329). 

Bodies  of  those  executed,  or  dying  in  hospitals  or  prisons 
under  sentence  for  crime,  shall  be  delivered  to  medical  college  or 
association  or  any  physician  or  surgeon  for  dissection,  etc., 
unless  relatives  or  friends  do  not  consent,  or  body  shall  have 
been  interred,  or  is  not  claimed  by  relatives,  or  deceased  ex- 
pressed a  wish  to  be  buried,  and  after  such  use  the  remains 
shall  be  interred  (Gen.  Stat.,  sec.  3,758). 

State  board  of  health  shall  issue  permits  for  transportation 
of  bodies  beyond  county  where  death  occurred  (Gen,  Stat.,  sec. 
6,030). 

Kansas. 

Coroner  to  hold  inquest,  etc.  (Gen.  Stat.,  sees.  1,780,  1,794). 

To  bury  body  if  not  claimed  b}'-  friends,  etc.,  and  at  public 
expense,  if  necessar}^  (Gen.  Stat.,  sec.  1,792). 

Removal  of  a  body  unlawfully  for  dissection  or  wantonly,  or 
receiving  body  knowing  it  to  have  been  so  removed,  is  a  mis- 
demeanor (Gen.  Stat.,  sec.  2,372  et  seq.). 

I  Kentucky. 

Coroner  to  hold  inquest,  etc.  (Gen.  Stat.,  ch.  25,  sees.  3, 11). 
To  bury  the  body  or  deliver  to  friends  (Gen.  Stat.,  ch.  25, 
sec.  6). 

Body  of  one  dying  on  a  steamboat,  or  other  craft,  if  not 


LOUISIANA— MARYLAND.  315 

claimed  by  friends,  shall  be  buried  by  master  or  officer  in  com- 
mand on  shore,  at  least  four  feet  deep  (Gen.  Stat.,  ch.  29,  art. 
17,  sec.  15). 

Removal  of  body  unlawfully  from  grave  is  punishable  (Gen. 
Stat.,  ch.  29,  art.  17,  sec.  IG). 

Louisiana. 

Coroner  shall  hold  inquest,  etc.,  and  bury  body  when  not 
claimed  by  friends  (Voorh.  Rev.  L.,  sees.  653,  GOO). 

Maine. 

Coroner  to  hold  inquest,  etc.  (R.  L.,  ch.  139,  sec.  1). 

To  bury  the  body  at  State  or  town  expense  (R.  L.,  ch.  139, 
sec.  11). 

Seizure  of  body  on  execution,  punishable  (R.  L.,  ch.  121, 
sec.  2G). 

Removal,  etc.,  of  body  unlawfully,  or  receiving  it  know- 
ingly, or  exposing,  etc.,  body,  is  punishable  (R.  L.,  ch.  121, 
sec.  27). 

Bodies  may  be  buried  and  the  expense  recovered  from  the 
town  (R.  L,,  ch.  24,  sec.  34). 

If  any  resident  request  or  consent  that  his  bodj-  be  deliv- 
ered to  a  physician  or  surgeon  for  dissection,  it  may  be  so  de- 
livered, unless  kindred  or  family  connection  objects  (R.  L., 
ch.  13,  sec.  1). 

Body  of  criminal  dying  in  State  prison  or  jail,  or  who  was 
executed,  maybe  delivered  to  medical  college  or  physician,  etc., 
for  dissection,  unless  deceased  or  kindred  request  to  be  buried 
(R.  L.,  ch.  13,  sec.  2). 

Body  of  person  dying  in  the  State,  which  is  not  claimed  by 
relatives,  notice  having  been  given,  shall  be  delivered  to  medical 
school  unless  ten  voters  of  the  town  object  to  such  disposition 
in  writing  (Laws,  1893,  ch.  251). 

Maryland. 

Coroner  to  hold  inquest,  etc.  (Md.  Code,  art.  22,  sees.  3,  1). 

Shall  bury  the  body  when  necessary  at  public  expense  (Md. 
Code,  art.  22,  sec.  7). 

Removal,  etc.,  from  grave5"ard,  etc.  (except  potter's  field), 
of  a  body  is  a  misdemeanor  (^Id.  Code,  art.  27,  sees.  133,  131). 


316         legal  status  of  the  dead  body — becker. 

Massachusetts. 

Medical  examiners  shall  hold  inquest,  etc.  (Pub.  Stat.,  ch. 
26,  sees.  10,  11). 

And  shall  deliver  it  to  relatives  or  friends,  or  if  no  one 
claims  it,  to  overseer  of  poor  etc.,  for  burial  (Laws,  1887,  ch. 
310). 

Body  shall  not  be  buried  in  city  or  town  or  removed  there- 
from without  a  permit  (Laws,  1888,  ch.  30(j). 

Body  of  one  dying  of  infectious  disease  shall  not  be  trans- 
ported without  permit,  and  only  in  a  sealed  case  (Laws,  1883, 
ch.  124,  sec.  2). 

Body  shall  not  be  cremated  without  permit  and  inquest  by 
medical  examiner,  or  within  forty-eight  hours  after  death,  un- 
less death  was  occasioned  by  contagious  disease  (Laws,  1885, 
ch.  265,  sec.  4). 

Overseers  of  poor,  mayor  and  alderman  of  city,  or  superin- 
tendent of  State  alms-house,  may  deliver  body  of  person  required 
to  be  buried  at  public  expense,  to  any  physician  or  surgeon  or 
medical  college  unless  deceased  requested  to  be  buried,  or  rela- 
tive request  burial  or  claim  it,  or  deceased  was  a  stranger  or 
traveller  (Laws,  1891,  ch.  185). 

Body  of  criminal  executed  shall  be  delivered  for  dissection 
to  a  medical  college  if  requested ;  if  not,  to  friends  or  relatives, 
or,  if  none,  to  any  physician  or  surgeon  (Pub.  Stat.,  ch.  202, 
sec.  8). 

Removal  of  body  unlawfully  from  grave  is  punishable,  or 
buying,  selling,  or  possessing  for  such  purpose,  is  punishable 
(Pub.  Stat.,  ch.  207,  sees.  47,  48). 

Concealing  birth  of  child  which,  if  born  alive,  would  be 
a  bastard,  is  punishable  (Pub.  Stat.,  ch.  207,  sec.  11). 

Seizing  dead  body  on  execution  is  punishable  (Pub.  Stat., 
ch.  207,  sec.  4G). 

Body  of  a  prisoner  shall  be  buried  by  sheriff  at  town  ex- 
pense if  not  claimed  by  relatives  or  friends  (Pub.  Stat.,  ch.  220, 
sec.  31). 

Michigan. 

Justice  of  the  peace  to  hold  inquest,  etc.  (How.  Am.  Stat., 
vol.  2,  sec.  9,583  et  seq.). 


MINNESOTA — MISSISSIPPI.  317 

And  shall  bury  the  body  at  the  State  or  town  expense  (How. 
Am.  Stat.,  vol.  .3,  sec.  9,593). 

Woman  concealing  death  of  issue  which,  if  born  alive, 
would  be  a  bastard,  is  punishable  (How.  Am.  Stat.,  vol.  3,  sec. 
9,284). 

Board  of  health,  officers,  sheriff,  etc.,  of  any  prison,  etc., 
poor-house,  alms-house,  having  body  required  to  be  buried  at 
public  expense,  shall,  if  not  claimed  by  relatives,  or  if  it  have 
died  of  any  infectious  disease,  deliver  it  to  University  of  Michi- 
gan, etc.,  for  dissection,  etc.  (How.  Am.  Stat.,  vol.  3,  sec.  2,284). 

Bod}'  shall  not  be  shipped  out  of  State  nor  used  in  State  for 
any  purpose  but  anatomical  study  (How.  Am.  Stat.,  vol.  3, 
sec.  2,286). 

Removal  of  body  unlawfullj'  is  punishable  (How.  Stat.,  vol. 
2,  sec.  9,297). 

Minnesota. 

Gen.  Stat.,  sees.  6,220,  6,230,  same  as  N.  Y.  P.  C,  sees.  305- 
315. 

Concealing  birth  of  child  which  died  before  or  after  birth 
is  a  misdemeanor  (Gen.  Stat.,  sec.  6,210). 

Coroner  to  hold  inquest,  etc.  (Gen.  Stat.,  sec.  1,011  et  seq.). 

And  cause  body  to  be  buried  at  expense  of  county  (Gen. 
Stat.,  sec.  1,021). 

Section  6,216,  same  as  303,  N.  Y.  P.  C. 

Body  must  be  buried  within  four  days,  and  if  death  was 
from  contagious  disease,  within  twenty-four  hours  and  in  a 
tightly  sealed  coffin  which  must  not  be  reopened  (Gen.  Stat., 
sec.  607). 

Wardens,  superintendents  of  poor,  and  other  persons  having 
control  of  bodies  shall  deliver  same  to  medical  college  com- 
mittee, for  dissection,  unless  claimed  by  relatives  or  friends, 
or  relatives  or  friends  do  not  consent,  or  one  detained  as  a 
witness  or  on  suspicion  of  having  committed  a  crime,  or  de- 
ceased requested  to  be  bfiried  (Gen.  Stat.,  sec.  678). 

Mississippi. 

Body  of  paupers  and  strangers  to  be  buried  (Am.  Code,  sees. 
3,145,  3,146). 

Coroner  to  hold  incjuest,  etc.  (Am.  Code,  sec.  816). 


318  LEGAL   STATUS   OF   THE   DEAD    BODY — BECKER. 

Removal  of  body  unlawfully  and  wantonly,  for  sale  or  re- 
ceiving same,  is  punishable  (Am.  Code,  sees.  1,023,  1,024). 

Missouri. 

Coroner  to  hold  inquest,  etc.  (R.  L.,  sec.  2,438  et  seq.). 

And  shall  bury  the  body,  if  not  claimed  by  friends,  at  public 
expense  (R.  L.,  sec.  2,456). 

And  may  direct  a  chemical  analysis  and  microscopical  ex- 
amination of  body  (R.  L.,  sec.  2,409). 

Superintendents  or  wardens  of  penitentiary,  houses  of  cor- 
rection, insane  asylums,  poor-houses,  and  coroners,  sheriffs,  city 
and  county  undertakers,  having  charge  of  a  body  required  to 
be  buried  at  public  expense,  shall  deliver  the  same  to  medical 
college  for  dissection  unless  claimed  by  relatives  or  friends,  and 
trafficking  in  such  bodies  is  a  misdemeanor  (R.  L.,  sec.  0,883 
et  seq.). 

Concealing  birth  of  child,  so  that  it  may  not  be  known 
whether  it  was  born  alive  or  dead,  is  a  felony  (R.  L.,  sec. 
3,479). 

Removal  of  dead  body  from  grave  without  authority  (except 
that  of  criminal  executed  for  crime),  for  purpose  of  sale,  etc., 
or  receiving  such  body  knowingly,  is  a  felony  (R.  L.,  sees. 
3,842,  3,845). 

Montana. 

Concealing  birth  of  child  which,  if  born  alive,  would  be  a 
bastard,  is  punishable  (Crim.  Laws,  sec.  41). 

Coroner  to  hold  inquest,  etc.  (Gen.  Laws,  sees.  809,  883). 

And  bury  bodj^  at  public  expense  if  not  claimed  by  relatives, 
etc.  (Gen.  Laws,  sec.  881). 

Removal,  etc.,  of  dead  body  from  grave  without  authority, 
and  for  the  purpose  of  sale  or  dissection,  or  from  wantonness, 
is  a  felony  (Laws,  1889,  p.  114). 

Nebraska.    • 

Coroner  to  hold  inquest,  etc.  (Consol.  Stat.,  sec.  3,130  etseq.). 

To  bury  body  if  not  claimed  by  friends  (Consol.  Stat.,  sec. 
3,144). 

Removal  of  body  from  grave  without  authority  for  sale, 
dissection,  etc.,  is  punishable  (Consol.  Stat.,  sec.  5,847). 


NEVADA — NEW   HAMPSHIRE.  319 

Foeticide  is  punishable  (Consol.  Stat.,  sec.  5,582). 

Bodies  of  paupers  or  criminals  unclaimed  by  friends  or  rela- 
tives may  be  delivered  to  medical  college  or  physician  for  dis- 
section, etc.,  and  such  body  shall  not  be  transported  out  of  State 
(Consol.  Stat.,  sees.  3,299,  3,301,  5,848). 

Nevada. 

Justice  of  peace  to  hold  inquest,  etc.  (Gen.  Stat.,  sec.  2,256 
et  seq.). 

And  cause  the  body  to  be  buried  at  public  expense  (Gen. 
Stat.,  sec.  2,2G9). 

Body  shall  not  be  buried  without  certificate  of  physician  or 
coroner  (Gen.  Stat.,  sec.  4,872  et  seq.). 

Body  shall  not  be  transported  out  of  State  without  a  permit 
(Gen.  Stat.,  sees.  4,870,  4,871). 

Concealing  birth  of  child  which,  if  born  alive,  would  be  a 
bastard,  is  punishable  (Gen.  Stat.,  sec.  4,597). 

Non-resident,  et  al.,  to  be  buried  at  public  expense  (Gen. 
Stat.,  sec.  1,986). 

New  Hampshire. 

Coroner  to  hold  inquest,  etc.  (Pub.  Stat.,  ch.  262,  sec.  1 
et  seq.). 

And  bury  body  if  a  stranger,  at  public  expense  (Pub.  Stat., 
ch.  262,  sec.  16). 

Concealing  birth  of  child  which,  if  born  alive,  would  be  a 
bastard,  is  punishable  (Pub.  Stat.,  ch.  278,  sec.  14). 

Body  of  person  dying  in  a  county,  city,  or  town,  or  State 
prison  or  jail,  required  to  be  buried  at  public  expense,  shall  be 
delivered  to  any  physician  or  medical  college  for  dissection, 
etc.,  unless  deceased  requested  to  be  buried,  or  friends  claimed 
it  or  request  burial,  or  deceased  was  a  stranger  or  traveller  who 
died  suddenly  (Pub.  Stat.,  ch.  136). 

Body  not  to  be  buried  without  permit  or  disinterred  (Pub. 
Stat.,  ch.  173,  sec.  6). 

Removal  of  dead  body  without  authority,  or  concealing  it, 
knowing  it  to  have  been  so  dug  up,  is  punishable  (Pub.  Stat., 
ch.  266,  sec.  7). 


320         legal  status  of  the  dead  body — becker. 

New  Jersey. 

Coroner  to  hold  inquest,  etc.  (Rev.  Stat.,  p.  170  et  seq.). 

And  bury  body  if  not  claimed  by  friends  (Rev.  Stat.,  p. 
170,  sec.  5). 

Concealing  birth  of  child  which,  if  born  alive,  would  be  a 
bastard,  is  a  misdemeanor  (Rev.  Stat.,  p.  241,  sec.  83). 

Body  of  executed  criminal  may  be  delivered  to  physician, 
etc.,  for  dissection  unless  claimed  by  relatives  (Rev.  Stat.,  p. 
239,  sec.  69). 

Removal  of  a  body  without  authority  for  sale,  dissection, 
etc.,  is  a  high  misdemeanor  (Rev.  Stat.,  p.  249,  sec.  122). 

Exposing  body  of  an  executed  murderer  is  a  misdemeanor 
(Supp.  Rev.  Stat.,  p.  194,  sec.  19). 

Body  must  not  be  buried  without  a  permit;  nor  body 
brought  into  the  State  without  permit ;  nor  taken  out  of  State 
without  permit  (Laws,  1888,  ch.  39,  sees.  5-8). 

New  Mexico. 

Justice  of  the  peace  to  hold  inquest,  etc.  (Comp.  Laws,  sec. 
443  et  seq.). 

And  bury  the  body  (Comp.  Laws,  sec.  447). 

Body  of  one  dying  of  a  contagious  disease  shall  not  be 
carried  in  an  open  coffin,  or  be  exposed  (Laws,  1889,  ch.  79, 
sec.  8). 

Body  shall  not  be  buried  within  fifty  yards  of  running 
stream  (Laws,  1891,  ch.  93). 

New  York. 

Duty  of  burial,  etc.  (Pen.  Code,  sec.  305  et  seq.). 

Attempt  at  sexual  intercourse  with  dead  body  is  a  crime 
against  nature  (Pen,  Code,  sec.  303). 

Transfer  of  body  of  one  who  died  of  a  contagious  or  infec- 
tious disease  shall  be  in  hermetically  sealed  casket  (Laws, 
1893,  ch.  661,  sec.  23). 

Bodies  of  those  djdng  in,  or  in  custody  of  managers,  etc.,  of 
any  prison,  asylum,  morgue,  hospital,  or  in  possession  of  un- 
dertakers, shall  be  delivered  to  medical  college  of  this  State,  etc. , 
for  purpose  of  medical  study,  unless  claimed  by  relatives  or 
friends,  or  friends  or  relatives  do  not  assent  to  such  disposal,  or 


NORTH   CAROLINA— NORTH   DAKOTA.  321 

deceased  requested  during  last  illness  to  be  buried  (Laws,  1893, 
ch.  661,  sec.  207). 

In  certain  cases  bodies  of  convicts,  unless  claimed,  shall  be 
delivered  to  certain  medical  colleges  (R.  S.,  pt.  4,  ch.  3,  sees. 
132,  133). 

District  attorney  may  cause  body  to  be  exhumed,  examined, 
etc.  (Pen.  Code,  sec.  308). 

North  Carolina. 

Coroner  to  hold  inquest,  etc.  (Code,  sec.  657). 

Concealing  birth  of  child,  by  burying  dead  body,  is  a  mis- 
demeanor. Opening  grave  without  authoritj'-  for  purpose  of 
taking  body  is  a  felony  (Laws,  1885,  ch.  90). 

Coroner  may  order  a  chemical  analysis  of  remains  (Laws, 
1887,  ch.  269). 

Dead  body  of  convict,  unclaimed  by  friends,  shall  be  deliv- 
ered to  medical  college  except  such  dying  of  contagious  disease 
(Laws,  1&91,  ch.  129). 

Body  of  one  dying  of  contagious  disease  must  not  be  trans- 
ported by  common  carrier  until  disinfected,  nor  shall  permit  for 
removal  be  issued  until  such  disinfection  (Laws,  1893,  ch.  214, 
sec.  16). 

North  Dakota. 

Coroner  to  hold  inquest,  etc.  (Comp.  Laws,  sec.  664  et  seq.). 

And  bury  the  bod}-  if  not  claimed  by  friends,  etc.  (Comp. 
Laws,  sec.  676). 

Concealing  birth  of  child  which,  if  born  alive,  would  be  a 
bastard,  or  of  child  dying  within  two  years  after  birth,  is  pun- 
ishable (Comp.  Laws,  sec.  6,947). 

Comp.  Laws. 

Sec.  6,549 same  as 305  N.  Y.  P.  C. 

6,550 "  306 

6,551 "  307 

6,552 "  308  (1-3) 

6,553 "  309 

6,554 "  310 

6,559 "  311 

6,560 "  312 

6,563 "  314 

31 


333  LEGAL  STATUS   OP  THE  DEAD   BODY — BECKER, 

Duty  of  burial  of  married  woman,  on  husband.  If  not  mar- 
ried woman,  on  nearest  of  kin  who  is  an  adult  or  has  means 
sufficient  (Comp.  Laws,  sec.  6,556). 

Refusal  to  bury  by  one  on  whom  duty  is  imposed  by  law,  a 
misdemeanor  (Comp.  Laws,  sec.  6,557). 

Custody  of  body  pertains  to  one  whose  duty  it  is  to  bury 
(Comp.  Laws,  sec.  6,558). 

When  cemetery  is  by  law  changed  to  other  place,  duty  is  on 
relative  to  move  body  (Comp.  Laws,  sec.  6,562). 

Body  of  executed  criminal,  and  those  dying  in  State  peni- 
tentiary or  county  jail  under  sentence,  shall  be  delivered  to 
medical  college  or  any  physician  for  dissection,  unless  deceased 
requested  to  be  buried,  or  friends  ask  to  have  it  buried,  or 
deceased  was  a  stranger  or  traveller  (Laws,  1890,  ch.  92). 

Ohio. 

Coroner  to  hold  inquest,  etc.  (R.  L.,  sec.  1,221  et  seq.). 

And  burj^  bod}^  etc.  (R.  L.,  sec.  1,227). 

Body  of  pauper  or  unknown,  not  an  inmate  of  any  penal, 
charitable,  or  reformatory  institution,  and  not  claimed  by  rela- 
tive or  delivered  for  dissection  according  to  law,  shall  be  buried 
at  public  expense  (Laws,  1890,  p.  283). 

Corpse  shall  not  be  conveyed  to  or  from  a  city  without  a 
permit  (R.  L.,  sec.  2,119). 

Bodies  of  those  dj^ing  in  city  hospitals,  city  or  county  in- 
firmaries, work-houses,  asylums,  charitable  institutions,  peni- 
tentiaries, or  jails,  which  are  required  to  be  buried  at  public  ex- 
pense, shall  be  delivered  to  medical  college  or  society  for  study, 
etc.,  unless  claimed  by  relative,  or  deceased  was  a  stranger  or 
traveller  (except  tramps)  (R.  L.,  sec,  3,763), 

Removing  body  from  grave  without  authority  for  dissection 
or  receiving  such  body  is  punishable  (R.  L.,  sec.  7,034). 

Body  of  executed  criminal,  if  not  claimed  by  relative  or 
friends,  may  be  delivered  for  dissection,  etc.  (R.  L.,  sec, 
7,343,  1). 

Oklahoma, 

Coroner  to  hold  inquest,  etc.  (Stat.,  sec.  1,745  et  seq.). 
And  bury  the  body  at  public  expense  if  not  claimed  by  rela- 
tives (Stat,,  sec,  1,759). 


OREGON — PENNSYLVANIA.  323 

Concealing  birth  of  issue  which,  if  born  alive,  etc.,  or  dying 
within  two  years  after  birth,  is  punishable  (Stat.,  sec.  2,179). 


(except  subd.  4) 
(ex.  punishment) 


2,188-2,190. 

.  same  as 

.  305-307  N.  Y.  P.  C 

2,191 

.  308 

2,192-2,193. 

.  309-310 

2,198 

.  311 

2,199 

.  312 

2,202 

.  314 

Custody  is  in  him  whose  duty  it  is  to  bury  (Stat.,  sees.  21, 
97). 

Duty  of  burial  of  married  woman,  on  husband ;  if  not  mar- 
ried woman,  on  nearest  of  kin  who  is  an  adult  and  has  suffi- 
cient means  (Stat.,  sec.  2,195). 

Refusal  to  bury  by  one  oai  whom  duty  rests,  is  a  misde- 
meanor (Stat.,  sec.  2,196). 

Oregon. 

Coroner  to  hold  inquest,  etc.  (Crim.  Code,  sec.  453  et  seq.). 

And  bury  body  if  not  claimed  by  friends  (Crim.  Code,  sec. 
462). 

Unmarried  woman  concealing  birth  of  child  so  that  it  may 
not  be  known  whether  it  was  born  alive  or  not,  is  punishable 
(Crim.  Code,  sec.  649). 

Bodies  of  criminals  executed,  those  dying  in  hospitals,  in- 
sane asylums,  alms-houses,  or  penitentiaries,  may  be  delivered 
to  medical  college  or  physician  for  dissection,  etc.,  unless  they 
shall  have  been  interred,  or  claimed  by  relatives,  or  relatives 
and  friends  do  not  consent,  or  deceased  expressed  a  wish  to  be 
buried;  and  they  shall  be  used  for  such  purpose  only  and  in 
this  State  (Hill's  Am.  Laws,  sec.  3,730  et  seq.). 

Removal  of  body  without  authority,  etc.,  is  punishable 
(Crim.  Code,  sec.  656). 

Pennsylvania. 

Coroner  to  hold  inquest  in  Philadelphia  County  only  in  case 
of  a  violent  death  (Bright  Pen.  Dig.,  1536,  sec.  37). 

And  may  in  Berks  and  Lancaster  Counties  order  a  post 
mortem  (Bright  Pen.  Dig.,  1536,  sec.  38). 


324  LEGAL   STATUS   OF   THE   DEAD   BODY — BECKER. 

Concealing  death  of  child  which,  if  born  alive,  would  be  a 
bastard,  is  punishable  (Bright  Pen.  Dig.,  431,  sec.  158). 

Removal  of  body  from  grave  without  authority  is  a  misde- 
meanor (Bright  Pen.  Dig.,  229,  sec.  11). 

Bodies  of  those  dying  in  alms-house,  hospital,  prison,  or 
public  institution,  or  those  in  morgue,  which  are  required  to  be 
buried  at  public  expense,  shall  be  delivered  to  medical  college, 
physician,  etc.,  to  be  used  for  scientific  purposes  only,  unless 
claimed  b}^  relatives  or  deceased  was  a  traveller,  and  trafficking 
in  such  bodies  is  a  misdemeanor  (Bright  Pen.  Dig.,  p.  9,  sec. 
1  et  seq.). 

Rhode  Island. 

Concealing  death  of  child  Avhich,  if  born  alive,  would  be  a 
bastard,  so  that  it  may  not  be  knf)wn,  etc.,  is  punishable  (Pub. 
Stat.,  ch.  244,  sec.  8). 

Seizing  dead  body  under  execution  is  punishable  (Pub.  Stat., 
ch.  223,  sec.  2). 

Bodies  of  those  dying  in  jail  shall,  if  not  claimed  by  relatives, 
be  buried  at  public  expense  (Pub.  Stat.,  ch.  201,  sec.  30). 

Medical  examiner  to  make  autopsy  (Pub.  Stat.,  1884,  ch. 
420). 

And  bury  body  of  stranger  at  State  expense  if  necessary 
(Pub.  Laws,  1884,  ch.  420,  sec.  24). 

Coroner  to  hold  inquest  if,  in  opinion  of  medical  examiner, 
death  was  caused  by  act  of  some  one  other  than  deceased  (Pub. 
Laws,  1884,  ch.  420,  sec.  17). 

South  Carolina. 

Coroner  to  hold  inquest,  etc.  (R.  L.,  sees.  711,  2,664  et  seq.). 
And  may  have  body  disinterred  for  inquisition  (R.  L. ,  sec. 
2,687). 

Tennessee. 

Coroner  to  hold  inquest,  etc.  (Code,  sec.  6,139  et  seq.). 

And  may  order  a  chemical  analysis  of  remains,  etc.  (Code, 
sec.  6,150). 

Body  to  be  buried,  if  not  claimed  by  relatives,  etc. ,  at  public 
expense  if  necessary  (Code,  sec.  6,160). 


TEXAS — VIRGINIA.  325 

Wilfully  and  improperly  exposing  or  abandoning  a  dead 
body  is  a  misdemeanor  (Code,  sec.  o,G58). 

Removing  or  purchasing  dead  bodies  without  authority  is  a 
misdemeanor  (Code,  sees.  5,659,  5,060). 

Body  of  deceased  convict  to  be  buried  unless  claimed  by 
friends  (Code,  sec.  6,403). 

Texas. 

Justice  of  the  peace  to  hold  inquest,  etc.  (Code  Crim.  P., 
art.  988  et  seq.). 

And  ma}"  disinter  the  body  for  such  inquisition  (Code  Crim. 
P.,  art.  989). 

Removal,  etc.,  of  dead  body  from  grave  without  authority 
is  punishable  (Code,  art.  345). 

Bodies  of  convicts  to  be  buried  (Rev.  C.  Stat.,  art.  3,561). 

Vermont. 

Justice  of  the  peace  to  hold  inquest,  etc.  (Rev.  Laws,  sec. 
3,934  et  seq.). 

Removal,  etc.,  of  dead  body  without  authority,  is  punishable 
(Rev.  Laws,  sees.  4,194,  4,196). 

Bodies  of  those  dying  in  poor-house  or  other  public  institu- 
tion, which  are  required  to  be  buried  at  public  expense,  may  be 
delivered  to  any  physician  for  dissection,  etc.,  unless  deceased 
requested  to  be  buried,  or  friends  or  relations  request  burial,  or 
deceased  was  a  stranger  or  traveller.  Such  body  shall  not  be 
removed  from  State,  and  shall  be  used  for  scientific  purposes 
only  (Laws,  1884,  ch.  85). 

Virginia. 

Coroner  to  hold  inquest,  etc.  (Code,  sec.  3,938  et  seq.). 

And  to  bur}?^  the  body  at  public  expense  (Code,  sec.  3,946). 

Removal,  etc.,  of  dead  body  from  grave  without  authority, 
is  punishable  (Code,  sec.  3,794). 

Bodies  of  those  dying  on  vessels  in  State,  shall  be  buried  by 
master  on  the  shore  above  high-water  mark  (Code,  sec.  2,002). 

Bodies  of  those  dying  in  alms-house,  prison,  morgue,  hos- 
pital, jail,  or  other  public  institution,  which  are  required  to  be 
buried  at  public  expense,  and  bodies  of  criminals  executed  for 


326  LEGAL  STATUS   OF   THE  DEAD   BODY — BECKER. 

crime  shall  be  delivered  to  medical  college,  etc.,  and  physician 
or  surgeon  for  anatomical  study,  unless  (except  criminals) 
relatives  and  friends  claim  the  body  or  deceased  was  a  stranger 
or  traveller ;  and  such  bodies  shall  not  be  sent  out  of  the  State 
(Code,  ch.  80). 

Washington. 

Coroner  to  hold  inquest,  etc.  (Hill's  Am.  Stat.,  vol.  1,  sec. 
?45  et  seq.). 

And  bury  body,  if  not  claimed  by  friends,  at  public  expense 
(Hill's  Am.  Stat.,  vol.  1,  sec.  257). 

Bodies  of  those  dying  in  j^oor-house,  public  hospital,  county 
jail,  State  prison,  etc.,  which  are  required  to  be  buried  at  public 
expense,  shall  be  delivered  to  medical  college,  physician,  sur- 
geon, etc.,  for  studj",  unless  deceased  requested  to  be  buried,  or 
it  is  claimed  by  friends  or  relatives,  or  deceased  was  a  stranger 
or  traveller;  and  such  body  shall  be  used  onlj'  in  the  State 
(Hill's  Am.  Stat.,  vol.  1,  sec.  2,428  et  seq.). 

Removal,  etc.,  of  body  from  the  grave  without  authority 
is  punishable  (Pen.  Code,  sec.  208). 

West  Virginia, 

Coroner  to  hold  inquest,  etc.  (Code,  ch.  154). 

And  bury  the  body  at  public  expense,  or  if  of  a  stranger, 
may  forward  it  to  its  destination  or  bury  it  (Code,  ch.  154, 
sec.  8). 

Removal,  etc.,  of  a  body  from  grave  is  punishable  (Code, 
ch.  149,  sec.  13). 

Wisconsin. 

Justice  of  the  peace  or  coroner  to  hold  inquest,  etc.  (S.  & 
B.  Am.  Stat.,  ch.  200). 

And  shall  cause  the  body  to  be  buried  at  public  expense  (S. 
&  B.  Am.  Stat.,  ch.  200,  sec.  4,877). 

Dead  body  of  convict  shall,  if  not  claimed  by  relatives  or 
friends,  be  buried  (S.  &  B.  Am.  Stat.,  sec.  4,926). 

Removal,  etc.,  of  body  from  grave  without  authority  is 
pimishable  (S.  &  B.  Am.  Stat.,  sec.  4,592). 

Concealing  death  of  child  which,  if  born  alive,  would  be  a 
bastard,  is  punishable  (S.  &  B.  Am.  Stat.,  sec.  4,585). 


WISCONSIN,  327 

A  public  officer  having  in  his  charge  a  body  required  to  be 
buried  at  public  expense,  shall  deliver  same  to  member  of  State 
or  county  medical  society,  etc.,  for  anatomical  stud}^,  unless 
claimed  by  relatives,  or  they  consent  to  such  disposal,  or  de- 
ceased requested  to  be  buried,  or  was  a  stranger  or  traveller 
(S.  &  B.  Am.  Stat.,  sec.  1,437). 


THE  POWERS  AND  DUTIES 


OF 


CORONERS  AND  MEDICAL  EXAMINERS. 


BY 

AUGUST   BECKER, 

Of  the  Buffalo  (iV.  Y.)  Bar. 


POWEES  AITD  DUTIES  OF  CORONEES 
AI^^D  MEDICAL  EXAMIl^EES. 

I.  The  Coroner  and  his  Court. 

Coroner  an  Ancient  Officer. — The  office  of  coroner  is  one 
of  the  most  important  and  ancient  known  to  the  common  law. 
A  coroner,  or  coronator,  was  so  called  because  he  had  princi- 
pally to  do  with  the  pleas  of  the  crown,  or  suit  wherein  the 
king  was  immediatel}"  concerned. '  The  office  is  first  mentioned 
in  a  charter  granted  in  the  year  925  by  King  Athelstan,  to  the 
authorities  of  BeverleJ^  The  office  as  at  present  constituted 
was  not  clearly  established  until  after  the  Norman  conquest. 

Under  this  head  come  the  lord  chief  justice  and  puisne  jus- 
tices of  the  King's  Bench,  who  are  supreme  and  sovereign  cor- 
oners respectively.^  The  duties  of  the  office  of  coroner  involve 
questions  of  the  greatest  interest  to  society,  to  government,  and 
to  the  rights  and  privileges  of  the  individual  citizen.  The  office 
has  lost  much  of  the  honor  and  respect  which  formerly  apper- 
tained to  it.  Its  character  and  importance  have  been  much 
diminished  in  latter  times,  making  striking  contrast  with  the 
high  estimation  it  was  held  in  by  our  ancestors  in  days  when 
none  but  the  gentry  and  knights  of  the  shire  were"  deemed 
eligible. 

In  fact  so  great  was  the  dignity  of  this  office  in  ancient 
times,  that  it  was  never  presumed  that  coroners  would  conde- 
scend to  be  paid  for  their  services.'  They  were  chosen  by  all 
the  freeholders  of  the  county  court  for  life  or  good  behavior, 
and  were  liable  to  be  removed  for  cause  b}^  the  writ  de  corona- 
tore  exonerando.  There  were  three  kinds  of  coroners  at 
common  law:  Virtufe  officii;  virtiite  cartce  sive  commis- 
sionis;  and  virtute  electionis."     The   office  of  coroner  was 

'Am.  &  Eng.  Enc.  of  Law,   vol.  »  j  Black.  Com.,  347. 

4.  p.  171.  ■*  Am.   &  Eng.  Enc.  of  Law,  vol. 

M  Co.,  57  ;  3  Com.  Dig.,  242.  4.  p.  173. 


332  POWERS   AND   DUTIES   OF   CORONERS — BECKER- 

brought  to  America  by  the  colonists  along  with  the  institutions 
of  the  common  law,  and  may  be  said  to  exist  in  the  several 
States  with  all  the  common-law  incidents,  except  so  far  as  they 
may  have  been  modified  by  statute.  The  present  defined 
powers  of  coroners  in  Great  Britain  and  the  United  States, 
unless  modified  by  British  statutes  and  American  acts,  are  de- 
rived from  the  English  Stat,  de  Officio  Coronatoris,  4  Edward 
I.,  s.  2.  Coroners  vii^tute  officii  and  virtute  cartce  sive  com- 
missionis  are  unknown  to  our  institutions.  Here  the  office  of 
coroner  may  be  classed  under  the  head  of  coroners  virtute  elec- 
tionis.     Generally  speaking  the  coroner  is  a  county  officer. 

Coroner's  Duties  both  Judicial  and  Ministerial. 

By  the  common  law  his  powers  and  duties  are  both  judicial 
and  ministerial.  In  his  ministerial  capacity  he  is  merely  a  sub- 
stitute for  the  sheriff,  as  when  the  sheriff  is  a  party.'  His 
powers  and  duties  thereunder  it  is  not  the  present  purpose  to 
state  and  define.  His  judicial  authority  relates  to  inquiries  into 
cases  of  sudden  death,  bj'  a  jury  of  inquest,  super  visum  cor- 
poris, or,  as  it  is  more  commonly  defined,  an  inquisition,  with 
the  assistance  of  a  jury,  over  the  body  of  an}^  person  who  may 
have  come  to  a  sudden  or  violent  death,  or  who  may  have  died 
in  prison.*  It  is  not  necessary  that  the  death  should  be  both 
violent  and  sudden,  and  that  both  these  circumstances  must  con- 
cur to  give  the  coroner  jurisdiction.  It  is  sufficient  to  give  the 
coroner  jurisdiction  if  the  death  occurs  from  any  violence  done 
to  a  person  by  another,  although  such  violence  maj^  not  have  ter- 
minated the  life  of  a  party  suddenly,  and  it  is  still  the  dut}^  of 
the  coroner  to  hold  an  inquest. '  Indeed  the  presumption  is  that 
he  has  acted  in  good  faith  and  on  sufficient  cause.  ^     And  so  when 

'  Giles  V.    Brown,  1  Mill  (S.  C.)  eye,    and    penetrating    the    brain. 

Const.,  230;   People  v.    Devine,  44  Surgical  aid  was  immediately  called 

Cal. ,  452.  in,  and  the  woman  received  all  the 

^Bouvier's  Law  Diet.,  vol.  1,   p.  care  and  attention  that  the  exigen- 

405.  cies  of  the  case   required  till  five 

^Lancaster    County    v.    Dern,     3  days  afterward,   when  she  died  in 

Grant   (Pa. ) ,    262.     In  this  case  a  consequence  of  the  woimd  received, 

concussion  or  collision  took  place  in  On  the  sixth  day  the  coroner  held 

a  street  between  the  sleighs  of  two  an  inquest,  and  in  this,  an  action  to 

parties,  whereby  a  woman  sustained  recover  for  his  services  against  the 

an  injury  bj-  the  shaft,  orsome  other  county,  it  was  Jield  he  could  recover, 

part  of  one  of  the  parties'  sleigh,  ■'Co'uutvof  Lancaster  t\   Mishler, 

striking  her  immediately  above  the  100  Pa.  St.,  624.     In  this,  a  suit  by 


coroner's  duties  both  judicial  and  ministerial.  333 

several  persons  have  been  suddenly  killed  by  the  same  violent 
cause,  under  circumstances  proper  to  be  inquired  of  by  a  coro- 
ner's inquest,  it  is  proper  and  necessary  for  the  coroner,  acting 
in  good  faith,  to  hold  a  separate  inquest  over  each  body.'  A 
coroner's  inquest  is  a  judicial  investigation.  The  coroner  can- 
not delegate  his  authority  to  any  one.  Neither  can  he  appoint 
a  deputy  under  the  common  law.  He  must  act  in  person  as 
any  other  judicial  officer ;  and  it  may  safely  be  said  that  a  cor- 
oner has  no  power  to  appoint  a  deputy  coroner,  except  where 
special  provision  is  made  therefor  bj'  statute."  In  England,  a 
coroner's  court  is  a  court  of  record,  and  it  has  according]}^  been 
held  that  trespass  cannot  be  maintained  for  turning  a  person 
out  of  a  room  where  the  coroner  is  about  to  take  an  inquisition.^ 
But  in  this  country,  it  may  safely  be  said  that  a  coroner's  court 
is  not  one  of  record,  but  of  inferior  jurisdiction.^  The  perform- 
ance of  the  functions  of  a  coroner  are  judicial  in  their  character ; 
so  judicial  that  he  is  protected  under  the  principles  which  pro- 
tect judicial  officers  from  responsibility  in  a  civil  action  brought 
by  a  private  person.     His  proceedings  amount  to  entries  con- 


the  coroner  against  the  county  to  re- 
cover his  fees,  it  was  held  that  this 
presumption  was  not  conclusive, 
and  evidence  was  admissible  to 
show  that  he  acted  in  bad  faith  and 
knowingly  without  sufidcient  cause 
or  reason.  The  Court  said  :  "The 
duty  of  a  coroner  to  hold  an  inquest 
rests  on  sound  reason,  on  that  reason 
which  is  the  life  of  the  law.  It  is 
not  a  power  to  be  exercised  capri- 
ciously and  arbitrarily  against  all 
reason.  The  object  of  an  inquest 
is  to  seek  information,  and  obtain 
and  secure  evidence,  in  case  of  death 
by  violence  or  other  undue  means. 
If  there  be  reasonable  ground  to 
suspect  it  was  so  caused,  it  becomes 
the"  duty  of  the  coroner  to  act.  If 
he  has  no  grounds  for  susi^ecting 
that  the  death  was  not  a  natural 
one,  it  is  a  perversion  of  the  whole 
spirit  of  the  law  to  compel  the 
county  to  pay  for  such  services." 

'  County  of  Fayette  v.  Batton, 
108  Pa.  St.,  591.  Itappeared  in  this 
case,  that  nineteen  ))ersons  came  to 
their  death  suddenly  and  almost 
simultaneously  by  an  explosion  of 
fire-damp  in  a  coal-mine.     The  cor- 


oner held  a  separate  inquest  over 
each  body  at  the  respective  homes 
of  the  deceased,  qualifying  the  same 
jury  separately  over  each  body,  and 
the  inquest  returned  a  separate  find- 
ing in  each  case.  It  was  Jield  that 
this  was  the  necessary  and  proper 
course  to  pursue  under  the  circum- 
stances, and  that  the  coroner  was 
entitled  to  the  legal  fees  in  each 
case.  In  Boislinieu  ^'.  Board  of  Co. 
Commissioners,  32  Mo.,  375,  it  was 
Jiekl  that  the  coroner  is  the  sole  judge 
as  to  the  propriety  or  necessity  of 
holding  the  iucpiest,  and  his  action 
in  that  respect  is  not  subject  to  re- 
vision by  the  county  commission- 
ers, and  he  is  entitled  to  fees  under 
the  statute  notwitlistanding  the  ver- 
dict of  th(i  coroner's  jury  discloses 
tliat  the  deceased  died  of  a  natural 
death,  and  not  by  casualty  or  vio- 
lence. 

-'  Am.  &  Eng.  Enc.  of  Law,  vol.  4. 
p.  175. 

'Garnett  v.  Ferrand,  6  Barn.  & 
Cress.,  (511. 

^  People  v.  Fitzgerald,  43  Hun 
(N.  Y.),  46. 


334  POWERS   AND    DUTIES   OF   CORONERS — BECKER. 

cerning  matters  of  public  interest,  made  under  the  sanction  of 
an  official  oath,  and  in  compliance  or  presumed  compliance  of 
the  law.' 

Of  his  AutJiority  to  Hold  an  Inquest. — His  authority  to 
hold  an  inquest  is  not  confined  to  the  body  of  a  person  who  may 
have  died  within  his  territorial  jurisdiction,  but  extends  to  all 
bodies  brought  within  his  jurisdiction,  no  matter  where  death 
may  have  taken  place."  So  in  any  case  where,  after  burial,  an 
inquest  becomes  necessary  to  determine  the  manner  of  the  death 
of  a  person  who,  dying  in  one,  is  buried  in  another  county,  the 
coroner  of  the  latter  county  is  the  proper  officer  to  hold  the  in- 
quest.' A  coroner  cannot  hold  a  second  inquest  while  the  first 
is  existing.  As  we  have  seen,  in  holding  an  inquest  the  coroner 
performs  a  judicial  duty,  and  he  is  functus  officio  as  soon  as 
the  verdict  has  been  returned.  He  can  hold  no  second  inquest 
in  the  same  case  unless  the  first  has  been  quashed  hj  a  court  of 
competent  jurisdiction,  and  a  new  inquiry  ordered.  He  can- 
not set  aside  or  quash  his  own  inquest.  If  he  were  allowed  to 
hold  two  inquests,  not  only  might  the  greatest  inconvenience 
arise  from  the  inconsistent  findings  of  the  respective  juries,  but 
such  a  practice  would  be  liable  to  great  abuse,  and  as  the  ob- 
ject of  the  proceeding  is  merely  preliminary,  the  main  purpose 
being  to  ascertain  whether  it  is  probable  that  a  crime  has  been 
committed,  and  to  examine  the  facts  and  circumstances  and 
preserve  the  evidence,  all  the  ends  of  this  inquiry  are  answered 
by  one  inquisition,  super  visum  corporis.  We  believe  no 
reported  case  is  to  be  found  in  this  country  where  a  second 
inquisition  has  been  held,  the  first  remaining  undischarged,  nor 
is  any  such  practice  known  to  or  recognized  by  our  laws.* 

'People  V.  Devine,  44  Cal.,  452;  ParkCrim.  Rep.  (N.Y.),519,  acoro- 

Common wealths.  Hawkins,  3  Gray  ner's  jury  found  that  the  death  was 

(Mass.),  463.  caused  by  suicide,  and  nearly  four 

■^  Peoples.  Fitzgerald,  105  N.  Y.,  months  afterward  the  coroner  sum - 

146.  moned    another   jury  and    held    a 

^Jameson  v.    Board    of    Comrs.,  second  inquest,   at  which  the  jury 

64  Ind. ,  524.  found  that  the  deceased  was  killed 

*  Regina  v.  White,  3  Ellis  &  Ellis  by  another,  whereupon  the  coroner 

(Eng.),  137.     In  this  case  a  second  issued  a    warrant  of   commitment 

inquisition  found    by  a   coroner's  under  which  the  accused  was  im- 

jury  was  quashed  by  the  court  upon  prisoned,   but  on  habeas  coi-2ms  he 

application  of  the  defendants  who  was  discharged  from  imprisonment 

were  charged   therein  with  wilful  on  the  ground  that  the  second  in- 

murder.     In    People    v.     Budge,    4  quisition  was  unauthorized. 


coroner  may  employ  professional  skill.         335 

The  Inquest  must  be  Held  upon  View  of  the  Body. 

The  coroner  can  in  no  case  hold  an  inquest  except  upon  view 
of  the  body.  This  is  jurisdictional  and  cannot  be  waived  by 
any  one.  He  is  not  bound  to  hold  a  inquest  before  burial  of  the 
body  takes  place.  When  it  has  been  buried,  and  he  believes  an 
inquest  necessary,  he  is  vested  with  authority  to  have  the  body 
disinterred  and  hold  his  inquest,  and  if  necessary  direct  a  post- 
mortem examination  to  be  made,  but  after  having  done  so,  he 
must  cause  it  to  be  reburied.'  Deep  interests  are  involved  in 
the  proper  discharge  of  the  duties  of  coroners;  the  character, 
liberty,  and  perhaps  the  life  of  a  citizen  accused  of  crime  on 
the  one  hand,  and  on  the  other  the  aiding  of  public  justice  in 
establishing  the  guilt  and  securing  the  punishment  of  the  actual 
criminal.  Many  of  the  questions  which  fall  within  the  scope  of 
a  coroner's  inquisition  are  of  an  intricate  and  most  perplexing 
character,  a  correct  solution  of  which  can  only  be  arrived  at  by 
minds  the  best  instructed  and  habituated  to  their  investiga- 
tion. In  many  cases  some  of  these  questions  can  be  satisfac- 
torily settled  by  the  evidence  of  persons  having  cognizance 
more  or  less  direct  of  the  facts;  in  others,  however,  they  can 
onlj^  be  solved  by  the  facts  deduced  from  pathological  anatomy, 
and  other  circumstances  connected  with  the  dead  body,  the 
cause  of  the  extinction  of  life  in  which  is  the  subject  of  the 
inquest. 

In  Massachusetts  Office  of  Coroner  Abolished. — Indeed, 
in  Massachusetts  the  office  of  coroner  was  abolished  in  1877, 
and  the  governor  was  invested  with  power,  and  it  is  his  duty, 
to  appoint,  by  and  with  the  advice  and  consent  of  the  council, 
able  and  discreet  men,  learned  in  the  science  of  medicine,  to 
be  medical  examiners,  whose  duties  are  to  make  examinations 
as  provided  in  the  statute  upon  the  view  of  the  dead  bodies  of 
such  persons  only  as  are  supposed  to  have  come  to  their  death 
by  violence.^ 

Coroner  may  Employ  Professional  Skill. — A  thorough  ex- 
amination aided  by  professional  skill  is  in  general  absolutely 
necessary  to  the  proper  administration  of  justice.  It  would  no 
doubt  be  strange  if  a  coroner  had  no  authority  to  pledge  the 

'The  King  v.  Ferrand.  3  Barn.  &  =  Mass.  Pub.  Stat,  chap.  26,  §§  1 

Aid.  (Eng.),  260  ;  2  Hawk  P.  C,  77.       and  10. 


336  POWERS   AND    DUTIES   OF   CORONERS — BECKER. 

responsibility  of  the  county  for  the  compensation  of  all  auxil- 
iary services  which  are  necessary  to  the  proper  execution  of  his 
office,  and  which  he  can  by  no  other  means  command ;  for  in- 
stance, when  his  duty  requires  him  to  disinter  a  body,  he  can- 
not be  expected  to  do  it  with  his  own  hands,  or  by  hands  paid 
for  with  his  means.  Indeed  it  has  been  said  that,  in  this  en- 
lightened age,  a  coroner  who  would  consign  to  the  grave  the 
body  over  which  he  had  held  an  inquest,  without  availing  him- 
self of  the  lights  which  the  medical  science  has  placed  within 
his  reach,  would  in  most  cases  fall  short  of  what  his  official 
duty  requires.'  It  is  the  generally  accepted  view  of  the  law 
now  that  it  is  the  duty  of  a  coroner  holding  an  inquest  super 
visum  corporis  to  avail  himself  of  professional  skill  and  aid, 
and  his  contract  will  bind  the  county  to  the  payment  of  a  rea- 
sonable compensation  for  making  a  post-mortem  examination.^ 

PosT-MoRTEM  Examination. 

Whether  such  examination  should  take  place  before  the  cor- 
oner has  empanelled  a  jury  seems  to  be  an  open  question.  We 
would  venture  the  opinion  that  it  should  not,  inasmuch  as  the 
jury  ought  to  see  and  view  the  body  in  the  same  condition,  as 
near  as  may  be,  as  it  was  when  found,  and  not  after  it  has  been 
mutilated,  as  it  must  need  be  by  a  post-mortem  examination. 

'  County  of  Northampton  r.  Innes,  tion.     County  of  Allegany  v.  Shaw, 

2  Casey  (Pa.),  156 ;  Commonwealth  34  Pa.  St.,  301.     It  has  been  held 

V.  Hannan,  4  Barr  (Pa.),  269.  that  the  authority  of  a  coroner  to  em- 

*  Allegany    County   v.    Watts,    3  ploj"  a  chemist  to  discover  whether 

Barr  (Pa.),  462;  Van  Hoevenbergh  poison  caused  the  death  of  one  on 

V.    Hasbrouck,    45  Barb.    (N.   Y. ) ,  whose  body  he  holds  an  inquest  does 

197.     The  New  York  legislature  has  not  restrict  him  to  the  employment 

made  provision  making  the  physi-  of  a  resident  of    the  county,   and 

clan's    services    in   such  a  case  a  that  the  analysis  of    the    chemist 

charge  against  tlie  county  and  the  must  not  be  made   in  the  county 

physician  must  look  to  the  county  of  the  coroner,  and  that  even  though 

for  his  pay.     Cosford  v.  Board  of  tlie  latter  was,  by  corrupt  applian- 

Supervisors,  38  N.  Y.  St.  Rep. ,  964  ;  ces  of  others,  induced  to  employ  a 

15  N.  Y.  Supp. ,  680.     In  Pennsyl-  chemist,  it  is  no  defence  to  a  suit  by 

vania  a  physician  or  surgeon,  em-  the  chemist  to  recover  compensation 

ployed  by  the  coroner  to  make  a  post-  for  his  services.     Board  of  Commis- 

mortem  examination,  may  recover  sioners  v.  Jameson,  86  Ind. ,  154. 
from  the  county  a  reasonable  com-  In    New  York  he  is  empowered 

pensation  for  his  services  ;  and  the  by  statute  to  employ  not  more  than 

county     commissioners     have     no  two   competent   surgeons  to  make 

power  to  appoint  a  surgeon  to  per-  post-mortem  examinations  and  dis- 

form  such  services,  so  as  to  preclude  sections  and  to  testify  to  the  same, 

tlie  coroner  from  selecting  a  proper  N.  Y.  Laws  of  1874,  chap.  535,  §  3. 
person,  in  the  exercise  of  his  discre- 


POST-MORTEM    EXAMINATION.  337 

It  is,  however,  settled  that  the  post  mortem  should  not  be  in  the 
presence  of  the  jury,  and  that  they  are  to  be  instructed  by  the 
testimony  of  the  physicians  who  are  designated  by  the  coroner 
to  make  the  examination.'  The  coroner's  right  to  dissect  the 
dead  body  of  a  human  being  does  not  extend  to  all  cases.  Such 
a  power  could  be  wielded  with  the  most  injurious  effects  upon 
a  community.  His  power  to  dissect  is  confined  to  those  cases 
where  he  is  authorized  by  law  to  hold  an  inquest  upon  the  body. 
But  a  post-mortem  examination,  conducted  by  surgeons  em- 
ployed by  a  coroner  holding  an  inquest,  is  not  a  part  of  the  in- 
quest in  such  a  sense  as  that  every  citizen  has  a  right  freely 
to  attend  it.  At  common  law  it  was  essent^'al  to  the  validity  of 
a  coroner's  inquisition  that  the  jury  should  view  the  body. 
And  so  is  our  law.  But  it  M'-as  never  required  that  the  body 
should  be  dissected  in  any  case.  It  is  discretionary  with  the 
coroner  to  cause  a  dissection  to  be  made,  and  to  select  the  sur- 
geons. He  has  also  a  discretion  to  determine  whether  any 
person,  and  what  persons,  may  be  present  besides  the  surgeons. 
Not  even  the  jurors  have  a  right  to  witness  the  examination. 
They  are  to  be  informed  of  what  it  discloses  by  the  testimony 
of  the  surgeons.  Indeed,  no  person  has  a  right  to  be  present  at 
the  post-mortem  examination  upon  the  ground  that  he  is  sus- 
pected of  having  caused  the  death.  He  loses  no  legal  right  by 
being  excluded.  He  has  no  right  to  dissect  the  body.  If  the 
coroner's  jury  pronounce  him  guilty,  the  inquest,  like  the  in- 
dictment of  a  grand  jury,  simply  makes  him  liable  to  arrest.  "^ 

'Peoples.  Fitzgerald,  105  N.  Y.,  ceeding  to  have  been  irregular,  a 
146.  In  this  case,  iipon  application  conviction  under  that  provision  of 
of  the  defendant  and  upon  affidavits  the  Penal  Code  could  not  be  sus- 
showing  sufficient  reasons  therefor,  tained,  and  this,  without  regard  to 
a  coroner  of  Chemung  County,  the  motives  which  actuated  tlie  de- 
N.  Y. ,  directed  the  exhumation  of  fendant ;  that  if  she  had  committed 
the  body  of  a  man,  who  died  in  any  offence  it  was  not  that  of  body- 
California  about  one  year  previous  stealing. 

and  was  buried  in  Chemung  County;  '^  Crisfield  r.  Perine,  15  Hun,  200, 

for  the  purpose  of  a  post-mortem  ex-  affirmed  81  N.  Y. ,  622.      This  was 

amination  to  determine  whether  the  an   action  of   assault  and    battery 

deceased   was    murdered,    and  the  and  it  appeared   that  the  defend - 

body  was  accordingly  exhumed,  and  ant  was  a  coroner,  and  that  he  held 

an   examination   had  without  em-  an  inquest  on  the  dead  body  of  a  jnan 

panelling  a  jury.     An   indictment  wlio   died  after  receiving  personal 

was  found  against  the    defendant  injuries  in  an  affray  which  he  had 

charging  her  with  body -steal  iugun-  with  his  nephew.     A  post-mortem 

der  section  311  of   tlie  New  York  examination  was  about  to  be  made 

Penal  Code,  against  body-stealing.  by  two  surgeons  employed  by  the 

It  was //dd  that  conceding  the  pro-  coroner  for  that  purpose.    The  plain- 


338         powers  and  duties  of  coroners — becker. 

Massachusetts  Statutory  Provisions. 

The  statute  law  of  Massachusetts  has  already  been  referred 
to.  It  has  abolished  the  office  of  coroner  and  in  its  place  put 
medical  examiners,  so  called,  who  are  presumed  to  be  learned 
in  the  science  of  medicine.  Their  powers,  however,  are  not 
co-extensive  with  those  of  coroners.  A  medical  examiner  can- 
not hold  an  inquest.  He  cannot  hold  an  autopsy  without  being 
thereto  authorized  in  writing  by  the  district  attorney,  mayor,  or 
selectmen  of  the  district,  city,  or  town  where  a  dead  body  lies. 
He  can  only  upon  receiving  notice  that  there  has  been  found, 
or  is  lying  within  the  county,  the  dead  body  of  a  person  who  is 
supposed  to  have  come  to  his  death  by  violence,  repair  to  the 
place  where  such  body  lies,  view  and  take  charge  of  the  same. 
If  he  deems  a  further  examination  necessary  and  is  authorized 
so  to  do,  he  must  make  an  autopsy  in  the  presence  of  two  or 
more  discreet  persons,  whose  attendance  he  may  compel  by  sub- 
poena if  necessarj^  and  he  must  then  carefully  reduce  or  cause 
to  be  reduced  to  writing  every  fact  and  circumstance  tending 
to  show  the  condition  of  the  body  and  the  cause  and  manner  of 
death,  together  with  the  names  and  addresses  of  the  witnesses. 
If  he  deems  it  necessary,  he  may  employ  a  chemist  to  aid  in  the 
examination  of  the  body  or  of  substances  supposed  to  have 
caused  or  contributed  to  the  death,'  the  record  of  which  he  must 
subscribe.^  Such  an  autopsy  does  not,  however,  upon  the  trial 
of  an  accused  render  other  competent  evidence,  as  to  the  con- 
dition and  appearance  of  the  dead  body  at  the  time  of  the 
autopsy,  inadmissible."  The  autopsy  may  be  followed  by  an 
inquest  held,  not  by  the  examiner,  but  by  a  justice  of  the  dis- 
trict, police,  or  municipal  court  for  the  district  or  city  in  which 
the  body  lies,  or  a  trial  justice.  One  of  these  functionaries 
must  hold  an  inquest  upon  being  notified  by  a  medical  examiner 
that  in  his  opinion  a  death  was  caused  by  violence,  and  after 
hearing  the  testimony  draw  up  and  sign  a  report  and  issue 
process  for  apprehension  of  a  person  charged  by  the  report  with 

tiff,  who  was  also  a  physician  and  of  the  room.     For  this  act  this  suit 

surgeon,  was  in  the  room  when  the  was  brought.     It  was  held  that  the 

examination  was  about  to  be  entered  suit  could  not  be  maintained, 

upon  and  said  that  he  wished  to  re-  '  Mass.  Pub.  Stat.,  chap  26,  §  19. 

main  and  witness  it,  but  the  coro-  -/Z>. ,  chap.  26,  t^  11. 

ner  asked  him  to  leave,  and  on  his  ^Commonwealth   v.    Dunan,    128 

refusing  caused  him  to  be  put  out  Mass. ,  432. 


NEW   YORK'S   STATUTORY   PROVISIONS.  339 

the  commission  of  an  offence,  if  he  is  not  in  custody.'  Even 
though  a  medical  examiner  reports  that  a  death  was  not  caused 
by  violence,  and  the  district  attorney  or  the  attorney-general  is 
of  a  contrary  opinion,  either  one  may,  notwithstanding  such 
report,  direct  an  inquest  to  be  held  in  accordance  with  the  pro- 
visions of  the  statute/ 

New  York's  Statutory  Provisions. 

In  New  York  the  powers  and  duties  of  coroners  are  defined 
by  statute.  Coroners  in  the  city  of  New  York  are  governed  by 
a  special  act  relating  to  that  city  exclusively.  For  the  State  at 
large  it  is  provided  that  whenever  a  coroner  is  informed  that  a 
person  has  been  killed  or  dangerously  wounded  by  another,  or 
has  suddenly  died  under  such  circumstances  as  to  afford  a  rea- 
sonable ground  to  suspect  that  his  death  has  been  occasioned 
by  the  act  of  another  by  criminal  means,  or  has  committed  sui- 
cide, he  must  go  to  the  place  where  the  person  is,  and  forthwith 
inquire  into  the  cause  of  the  death  or  wounding,  and  summon 
not  less  than  nine  nor  more  than  fifteen  persons,  qualified  by 
law  to  serve  as  jurors,  if  such  death  or  wounding  be  of  a  crim- 
inal nature,  to  appear  before  him  forthwith  at  a  specified  place, 
to  inquire  into  the  cause  of  death  or  wound,  and  if  it  appears 
from  the  evidence  taken  or  during  the  inquisition,  that  any 
person  or  persons  are  chargeable  with  the  killing  or  wounding, 
or  that  there  is  probable  cause  to  believe  that  any  person  or 
persons  are  chargeable  therewith,  and  if  they  are  not  in  custody 
the  coroner  must  forthwith  issue  a  warrant  for  the  arrest  of  the 
person  or  persons  charged  with  such  killing  or  wounding,  who 
must  be  arraigned  before  the  coroner  for  examination,  and  the 
coroner  has  power  to  commit  the  person  or  persons  so  arrested 
to  await  the  result  of  the  inquisition.  A  coroner  is  disqualified 
from  acting  as  such  in  any  case  where  the  person  killed  or 
dangerously  wounded  is  a  co-emplo3'ee  with  the  coroner  of  any 
person  or  persons,  association  or  corporation,  or  where  it  appears 
that  the  killing  or  wounding  has  been  occasioned,  directly  or 
indirectly,  by  the  employer  of  the  coroner.'  It  is  further  pro- 
vided that  whenever  a  convict  shall  die  in  any  State  prison,  it 
shall  be  the  duty  of  the  inspector  having  charge  of  the  prison 

'  Mass.  Pub.  Stat. ,  chap.  26,  gg  13,  -  IMass.  Pub.  Stat. .  chap.  26,  g  18. 

13,  17.  2]sf.  Y.  Criminal  Code,  §  773. 


340  POWERS   AND   DUTIES   OF   CORONERS — BECKER. 

and  of  the  warden,  physician,  and  chaplain  of  the  prison,  if 
they  or  either  of  them  shall  have  reason  to  believe  that  the  death 
of  the  convict  arose  from  any  other  than  ordinary  sickness,  to 
call  upon  the  coroner  having  jurisdiction  to  hold  an  inquest 
upon  the  body  of  such  deceased  convict/  The  New  York  Crim- 
inal Code  further  provides  that  when  six  or  more  of  the  jurors 
appear,  they  must  be  sworn  by  the  coroner  to  inquire  who  the 
person  was,  and  when,  where,  and  by  what  means  he  came  to 
his  death  or  was  wounded  as  the  case  may  be,  and  into  the  cir- 
cumstances attending  the  death  or  wounding,  and  to  render  a 
true  verdict  thereon  according  to  the  evidence  offered  to  them 
or  arising  from  the  inspection  of  the  body.^  The  coroner  may 
issue  subpoenas  for  and  summon  and  examine  as  witnesses 
every  person  who  in  his  opinion,  or  that  of  any  of  the  jury,  has 
any  knowledge  of  the  facts ;  and  he  must  summon  as  a  witness 
a  surgeon  or  physician,  who  must,  in  the  presence  of  the  jury, 
inspect  the  body,  and  give  a  professional  opinion  as  to  the  cause 
of  the  death  or  wounding.  ^  The  jury,  after  inspecting  the  body 
and  hearing  the  testimony,  must  render  their  verdict,  and  cer- 
tify it  by  an  inquisition  in  writing,  signed  by  them,  and  setting 
forth  who  the  person  killed  or  wounded  is,  and  when,  where, 
and  by  what  means  he  came  to  his  death  or  was  wounded,  and 
if  he  were  killed  or  wounded,  or  his  death  were  occasioned  by 
the  act  of  another  by  criminal  means,  who  is  guilty  thereof, 
in  so  far  as  by  such  inquisition  they  have  been  able  to  ascertain.* 
The  testimony  of  the  witnesses  examined  before  the  coroner's 
jury  must  be  reduced  to  writing  by  the  coroner,  or  under  his 
direction,  and  must  be  forthwith  filed  by  him,  with  the  inquisi- 
tion, in  the  office  of  the  clerk  of  the  court  of  sessions  of  the 
county,  or  of  a  city  court  having  power  to  inquire  into  the  offence 
by  the  intervention  of  a  grand  jury.^ 

If,  however,  the  defendant  be  arrested  before  the  inquisition 
can  be  filed,  the  coroner  must  deliver  it  with  the  testimony  to 
the  magistrate  before  whom  the  defendant  is  brought.'  If  the 
jury  find  that  the  person  was  killed  or  wounded  by  another 
under  circumstances  not  excusable  or  justifiable  by  law,  or  that 
his  death  was  occasioned  by  the  act  of  another  by  criminal 

'  N.  Y.  Revised  Statutes,  part iv. ,  *Ib.,  %  777. 

chap,  iii.,  §102.  Ub.,  8  778. 

■  N.  Y.  Criminal  Code,  §  774.  « i6. ,  §  779. 
Ub.,  §775. 


THE    JUKY   AND    INQUEST.  341 

means,  and  the  party  committing  the  act  be  ascertained  by  the 
inquisition  and  is  not  in  custody,  the  coroner  must  issue  a  war- 
rant signed  b}^  him  with  his  name  of  oflSce,  for  the  arrest  of  the 
person  charged.'  The  coroner  has  power  to  compel  the  attend- 
ance of  a  witness  and  testify,  and  he  ma}^  punish  a  witness  for 
disobedience,  as  upon  a  subpoena  issued  by  a  magistrate.^  The 
coroner's  warrant  may  be  served  in  any  count}' ;  and  the  officer 
serving  it  must  proceed  thereon,  in  all  respects,  as  upon  a  war- 
rant of  arrest  on  an  information,  except  that  when  served  in 
another  county  it  need  not  be  indorsed  by  a  magistrate  of  that 
county.^  When  the  defendant  is  brought  before  the  coroner, 
he  must  proceed  to  examine  the  charge  contained  in  the  inqui- 
sition or  information,  and  hold  the  defendant  to  answer,  or  dis- 
charge him  therefrom,  in  all  respects  as  upon  a  warrant  of 
arrest  on  an  information.^ 

II.  The  Jury  and  Inquest. 

Jurors  Must  be  Sworn  by  Coroner. — The  jurors  summoned 
by  a  coroner  to  attend  an  inquest  must  be  from  the  county  or 
jurisdiction  wherein  the  coroner  is  empowered  to  act.  He  can- 
not proceed  with  the  inquest  until  he  has  summoned  and  sworn 
the  jury.  The  jurors  are  not  challengeable,  and  therefore  they 
should  be  carefully  selected  and  sworn  by  the  coroner  himself. 
His  duties  are  judicial  and  he  can  only  take  an  inquest  super 
visum  corporis,  and  an  inquest  in  which  the  jury  is  not  sworn 
by  himself  is  absolutely  void  and  of  no  effect. '" 

They  Must  Investigate  and  Determine  the  Facts. — After 
being  sworn  by  the  coroner  they  must  investigate  and  deter- 
mine and  are  the  sole  arbiters  of  the  facts ;  the  coroner's  duty 
being  to  instruct  them  in  the  law.  The}'  must  go,  view,  and 
examine  the  body  together,  and  not  separately.  It  is  essential  to 
the  validity  of  the  inquest  that  the  jury  should  view  the  body.' 

Coroner  may  Compel  Attendance  of  Witnesses. — When 
the  coroner  sits  to  hold  an  inquest,  he  sits  as  a  judicial  officer, 
armed  with  all  the  ordinary' powers  possessed  by  judicial  officers. 
He  may  compel  the  attendance  of  jurors  whose  qualifications 

1 N.  Y.  Crim.  Code,  §  780.  "*  2  Hawk  P.  C. ,  77  ;  King  v.  Fer- 

2  76.,  §776  rand,  3  Barn.  &  A.  (Eng.),  2G0. 

3J6.,  §782.  «Rex  v.    Ferrand,   3  B.   «&:  Aid., 

< lb.,  §783.  260. 


342     POWERS  AND  DUTIES  OF  CORONERS — BECKER. 

are  usually  such  as  are  required  of  jurors  in  a  court  of  record. 
It  is  his  duty  to  present  before  the  jury  all  the  material  testi- 
mbny  within  his  power,  touching  the  death  as  to  the  manner 
whereof  the  jury  are  to  certify,  and  that  which  makes  for  as  well 
as  against  the  party  accused.  It  is  his  duty  to  summon  before 
his  inquest  every  person  whom  he  has  any  reason  to  believe 
possesses  anj^  knowledge  relative  to  the  death  which  he  is  inves- 
tigating. He  is  to  summon  such  persons  to  attend  before  him 
for  examination.  He  has  full  authority  to  compel  obedience  to 
his  subpcenas.  He  has  this  power  by  the  common  law.'  If  a 
post-mortem  examination  is  made,  the  examining  surgeons 
should  testify  before  the  jury  as  to  the  matters  disclosed  by 
the  examination.^  The  witnesses  produced  must  be  sworn  by 
the  coroner,  and  their  testimony  reduced  to  writing  by  him  or 
under  his  direction. 

Eights  of  Accused  Party. 

The  coroner  is  not  required  to  take  the  testimony  of  the 
witnesses  who  are  examined  before  the  jury  in  the  presence  of 
the  party  accused.  The  accused  has  not  the  right  to  be  repre- 
sented by  counsel,  or  to  cross-examine  the  witnesses.^  He  is 
not  permitted  to  produce  witnesses  before  the  coroner  to  show 
himself  innocent  of  the  crime.  The  coroner  is  not  required  to 
examine  any  witnesses  to  establish  the  guilt  of  such  party  when 
brought  before  him  by  virtue  of  process  issued  after  the  finding 
of  the  inquisition." 

Deliberation  by  Jury  and  Return  of  an  Inquisition. — 
After  the  evidence  has  been  taken,  and  the  jury  instructed  in 
the  law  by  the  coroner,  the  jury  should  retire  to  deliberate  upon 
their  verdict.  During  such  deliberation  and  until  they  have 
arrived  at  their  verdict  the  coroner  should  not  be  present  in  the 
room  where  the  jury  is  deliberating.  After  they  have  agreed 
on  their  verdict  it  should  be  reduced  to  writing,  and  the  coroner 

^In  re  Coroners,  11  Phila.  (Pa.),  person  charged  with  murder  is  not 

^87.  void  for  the  omission  of  the  allega- 

•^  Crisfield  v.  Ferine,  15  Hun,  200,  tiou  that  he  caused  the  death  "fe- 

aflftrmed  81  N.  Y. ,  632.  loniously, "  if  it  is  such  that  the  fact 

•^2  Hawk  P.  C,  77.  that  he  caused  tlie  death  feloniously 

^  Matter  of  Collins,    11  Abb.    Pr.  mav  be  collected  on  its  face.     And 

(N.  Y.),  406;  20  How.  Pr.,  111.   In  see  People  r.  Beigler,  3  Park  Crim. 

this  case  it  was  held  that  a  commit-  Rep.   (N.  Y.),  316. 
ment  issued  by  a  coroner  against  a 


THE   EFFECT   OF   THE   EVIDENCE   AND   VERDICT,  343 

is  bound  to  accept  it  as  final  in  his  court.  The  inquisition 
should  then  be  signed  by  the  coroner  and  jury.'  If  the  inquest 
is  signed  by  the  coroner  and  duly  certified  by  him,  the  jurors 
having  signed  by  making  their  cross  marks,  and  the  whole 
being  certified  by  the  coroner,  his  certificate  of  the  signatures 
of  the  jurors  is  sufficient  and  the  inquisition  is  properly  made." 
If  several  jurors  on  the  inquest  have  the  same  christian  and 
surname,  it  is  not  necessary  in  the  caption  of  the  inquisition  to 
distinguish  them  by  abode  or  otherwise.''  The  law  requiring 
the  coroner  to  make  a  return  of  the  testimony  with  the  inquisi- 
tion cannot  be  satisfied  short  of  some  official  certificate  indi- 
cating that  the  witnesses  named  were  sworn  before  him,  to  the 
matter  insisted  on  as  evidence  against  a  prisoner.  At  least  if 
there  be  no  formal  authentication,  there  should  be  proof  aliunde 
that  the  memorandum  presents  the  testimony  of  the  witness 
truly.' 

III.  The  Effect  of  the  Evidence  and  Verdict. 

Under  the  common  law  formerly,  a  coroner's  inquisition 
was  equivalent  to  an  indictment  by  a  grand  jury  upon  which 
the  accused  might  be  tried.  But  in  this  country  no  person  can 
be  tried  upon  a  coroner's  inquisition,  yet  the  inquisition  of  a 
coroner's  jur}'  finding  a  person  guilty  of  murder  has  about  the 
same  force  against  him,  until  the  grand  jur}^  passes  upon  his 
case,  that  an  indictment  found  by  them  has  thereafter,  prior  to 
his  trial. 

Coroner  has  Power  to  Issue  Process  of  Apprehension. — 
If  a  person  is  charged  with  the  crime  in  the  inquisition,  the 
coroner  has  power  and  he  issues  his  process  for  the  apprehen- 
sion of  the  accused  when  not  in  custody  solely  upon  the  inqui- 
sition. The  inquisition,  though  taken  in  the  absence  of  the 
prisoner,  and  upon  the  testimony  of  witnesses  he  could  not 
cross-examine,  settles  the  question  of  his  guilt  until  the  grand 
jury  passes  upon  the  case.  It  justifies  the  commitment  of  the 
prisoner  to  jail,  in  the  same  manner  that  the  testimony  of  wit- 
nesses does  taken  before  a  justice  of  the  peace.  The  coroner 
can  only  examine  the  prisoner  in  the  same  manner  as  upon  a 

'  Rex  V.  Bowen,  6  Car.  &  P. ,  602  ;  '  Rex  v.  Nicholas,  7  Carr  &  Payne 

Rex  V.  Bennett,  6  Car.  &  P.,  179,  (Eng.),  538. 

^ States.  Evans,  27  La.  An.,  297.  ••People  v.  White,   22  Wend.  (N. 

Y.),  167. 


344  POWERS   AND   DUTIES   OF   CORONERS — BECKER. 

warrant  of  arrest  or  on  information,  and  is  not  authorized  to 
examine  witnesses  either  against  the  prisoner  or  for  him,  when 
he  is  apprehended  by  virtue  of  process  issued  subsequent  to  the 
finding  of  the  inquisition  by  the  jury,  or  in  custody  of  the  cor- 
oner without  process  at  the  time  the  same  is  found. 

Privilege  of  Prisoner  upon  Arrest. — The  prisoner  has  the 
privilege  of  telling  his  own  story  before  the  coroner,  which  is 
to  be  returned  with  the  inquisition,  and  that  is  all.  He  cannot 
be  discharged  on  it,  however  plausible  it  may  be ;  and  he  has 
not  the  privilege  of  proving  it  true  before  the  coroner.  He 
should,  therefore,  not  be  discharged,  and  he  cannot  have  the 
case  investigated  again  before  it  is  passed  upon  by  the  grand 
jury.' 

Under  the  provisions  of  the  Neiv  York  Criminal  Code 
the  defendant  against  whom  an  inquisition  has  been  found  by  a 
coroner's  jury  is  entitled  to  a  hearing  before  a  magistrate, 
whether  he  has  been  arrested  before  the  inquisition  has  been 
filed  or  is  arrested  after  such  filing.  Under  the  provisions  of 
sec.  779,  in  the  case  of  a  defendant  who  has  been  arrested  be- 
fore the  inquisition  can  be  filed,  the  prisoner  is  entitled  to  be 
examined  before  the  magistrate,  before  whom  he  may  be 
brought,  as  provided  in  sec.  781,  and  in  the  case  of  a  prisoner 
who  has  not  been  arrested  until  after  the  inquisition  was  filed, 
UTider  sees.  781  and  783  the  defendant  is  entitled  to  be  heard 
before  a  magistrate  in  all  respects  as  upon  a  warrant  of  arrest 
on  an  information.  The  magistrate  must  proceed  to  examine 
the  charge  contained  in  the  inquisition,  and  hold  the  defendant 
to  answer  or  discharge  him  therefrom.'^  The  information  is 
the  allegation  made  to  a  magistrate  that  a  person  has  been 
guilty  of  some  designated  crime.  ^ 

When  Evidence  taken  before  Coroner  of  a  Party 
Charged  with  Crime  Admissible  in  Evidence  upon 
His  Trial  Subsequently. 

There  is  nothing  which  distinguishes  between  the  proceed- 
ings of  a  coroner's  inquest  and  any  other  official  proceedings 

'Matter  of  Collins,   11  Abb.   Pr.  ment   issued  by  a  coroner,   he  not 

(N.  Y.),  406;  20  How.  Pr. ,  111.  having   had   an   examination,    and 

-Matter  of  Ramscar,  10  Abb.   N.  the  Court  dii-ected  an  examination 

C.    (N.   Y. ) ,  443.     The  prisoner  in  before  a  magistrate, 

this  case  was  detained  on  a  commit-  ^N.  Y.  Code  Crim.  Pro.,  §  145. 


EVIDENCE   TAKEN   BEFORE   CORONER.  345 

taken  and  returned  in  the  discharge  of  official  duty  as  to  their 
admissibility  in  evidence.  A  witness,  therefore,  may  be  con- 
tradicted by  the  production  of  a  deposition  thus  given  by  him 
before  a  coroner. '  But  the  line  is  sharpl}^  drawn  in  what  cases 
the  testimony  of  a  witness  examined  before  a  coroner's  inquest 
can  be  used  on  his  subsequent  trial,  and  in  what  cases  it  can- 
not. When  a  coroner's  inquest  is  held  before  it  has  been  as- 
certained that  a  crime  has  been  committed,  or  before  any  person 
has  been  arrested  charged  with  the  crime,  and  a  witness  is 
called  and  sworn  before  the  coroner's  jury,  the  testimony  of  that 
witness,  should  he  afterward  be  charged  with  the  crime,  may 
be  used  against  him  on  his  trial,  and  the  mere  fact  that  at  the 
time  of  his  examination  he  was  aware  that  a  crime  was  sus- 
pected, and  that  he  was  suspected  of  being  the  criminal,  will 
not  prevent  his  being  regarded  as  a  mere  witness,  whose  testi- 
mony may  be  afterward  given  in  evidence  against  himself.  If 
he  desires  to  protect  himself  he  must  claim  his  privilege.  But 
if,  at  the  time  of  his  examination,  it  appears  that  a  crime  has 
been  committed,  and  that  he  is  in  custody  as  the  supposed 
criminal,  he  is  not  regarded  merely  as  a  witness,  but  as  a  party 
accused,  called  before  a  tribunal  vested  with  power  to  investi- 
gate preliminarily  the  question  of  his  guilt,  and  he  is  to  be 
treated  in  the  same  manner  as  if  brought  before  a  committing 
magistrate,  and  an  examination  not  taken  in  conformity  with 
the  statute  cannot  be  used  against  him  on  his  trial  for  the 
offence.'"'  So  the  doctrine  as  to  silence  being  taken  as  an  im- 
plied admission  of  the  truth  of  allegations  spoken  or  uttered  in 
the  presence  of  a  person,  does  not  apply  to  silence  at  a  judicial 
proceeding  or  hearing,  and  since  the  proceedings  at  a  coroner's 
inquest  are  of  a  judicial  character,  what  there  transpired  must 
be  considered  as  a  part  of  the  proceedings."     The  leading  cases 

'  People  V.  Devine,  44  Cal. ,  453 ;  called  at  hev  house  and  asked  the 

Commonwealths.  Hawkins,  3  Gray  way  to  Sandy  Hill,  and  also  for  a 

(Mass.).  463.  drink  of  water;  that  the  prisoner 

i People  V.    Monden,    103  N.   Y. ,  witli  a  number  of  others  was  placed 

211.  arovmd  a   room,    and    the  witness 

'People  V.  Willett,  93  N.  Y. ,   39.  pointed  out  the  prisoner  as  the  one 

In  this  case  upon  the  trial  of  an  in-  who  so  called  ;  also  that  a  number 

dictment  for  murder,  evidence  was  of  persons,   including  tlie  prisoner 

received  on  the  part  of  the  prosecu-  passed  behind  her,  each  one  repeat- 

tion,  imder  objection  and  exception,  inp;  the  question  asked  lier  by  the 

to  the  effect  that  upon  the  coroner's  stranger,    and    slie    identified    tlie 

inquest    a    witness    testified     that  prisoner  bj-  his  voice,  and  that  the 

shortly  after  the  murder  a  stranger  prisoner  on  that  occasion  did  not 


346  POWERS   AND   DUTIES   OF   CORONERS — BECKER, 

which  have  been  before  the  New  York  Covirt  of  Appeals  upon 
this  important  question,  and  from  which  that  court  has 
finally  deduced  that  rule,  may  be  here  referred  to. 

Hendrickson  Case. — In  the  first  case  the  wife  of  the  defendant  died 
suddenly  in  the  morning,  and  in  the  evening  of  the  same  day  a  coro- 
ner's inquest  was  held.  The  defendant  was  called  and  sworn  as  a  wit- 
ness upon  the  inquest.  At  that  time  it  did  not  appear  that  any  crime 
had  been  committed,  or  that  the  defendant  had  been  charged  with  any 
crime,  or  even  suspected,  except  so  far  as  the  nature  of  some  of  the 
questions  asked  of  him  might  indicate  such  a  suspicion.  On  his  subse- 
quent trial  on  an  indictment  for  the  murder  of  his  wife,  the  statements 
made  by  him  at  the  coroner's  inquest  were  held  admissible,  on  the 
ground  that  he  was  not  examined  as  a  party  charged  with  the  crime; 
that  it  had  not  appeared  even  that  a  crime  had  been  committed,  and 
that  he  had  simply  testified  as  a  witness  on  the  inquiry  as  to  the  cause 
of  the  death. ' 

McMahon  Case. — Following  this  came  the  McMahon  Case.,  in  which 
it  appeared  that  the  defendant  was  arrested  by  a  constable,  without 
warrant,  on  a  charge  of  having  murdered  his  wife.  The  constable 
took  him  befoi*e  the  coroner,  who  was  liolding  an  inquest  on  the  body, 
b}'  whom  he  was  sworn  and  examined  as  a  witness.  It  was  held  that 
the  evidence  thus  given  was  not  admissible  on  the  prisoner's  trial  for 
the  murder,  and  his  conviction  was  rever.sed  vipon  that  ground.'^ 

Teachout  Case. — The  doctrine  of  this  case  was  more  clearly  defined 
and  somewhat  limited  in  a  later  case,  the  Teachout  Case.  In  that  case 
the  defendant  appeared  at  the  coroner's  inquest  in  pursuance  of  a  sub- 
poena to  testify,  and  voluntarily  attended;  he  was  not  imder  arrest,  but 
was  informed  by  some  one  that  it  was  charged  that  his  wife  had  been 
lX)isoned  and  that  he  would  be  arrested  for  the  crime.     Before  he  was 

deny  that  he  was  such  stranger.  It  was  erroneously  received.  It  is 
was  held  that  the  prisoner  was  not  very  apparent  that  the  examination 
bound  to  speak  and  his  silence  could  before  the  coroner  partook  of  a  ju- 
not  be  regarded  as  an  evidence  of  dicial  character,  and  what  then 
guilt,  and  that  the  evidence  was  im-  transpired  must  be  considered  as  a 
proi3erly  received.  The  Court  said  :  part  of  the  proceedings  ;  the  coro- 
"The  question  whether  the  defend-  ner  was  there,  a  jury  had  been  em- 
ant  was  bound  to  speak,  and  under-  panelled,  and  witnesses  were  exam- 
stood  that  he  was  at  liberty  to  speak,  ined  whose  testimony  was  returned 
if  he  chose,  was  submitted  to  the  as  a  portion  of  the  coroner's  pro- 
jury  bj' the  Court  in  his  charge,  and  ceedings.  It  is  difficult  to  see 
an  exception  taken  thereto.  The  upon  what  ground  it  can  be  claimed 
doctrine  as  to  silence  being  taken  that  the  experiments  which  were 
as  an  implied  admission  of  the  truth  made  were  not  in  connection  with 
of  allegations  spoken  or  uttered  in  the  proceedings  before  the  coroner 
the  presence  of  a  person,  does  not  ap-  and  a  part  thereof. " 
ply  to  silence  at  a  judicial  proceed-  ^Hendrickson  v.  People,  10  N. 
ing  or   hearing.     And   if   the  pro-  Y. .  13. 

ceedings  before  the  coroner  were  of  ■  People  u  McMahon,   15  N.   Y. , 

a  judicial  character  the  evidence  384. 


EVIDENCE   TAKEN   BEFORE   CORONER.  347 

sworn  he  was  informed  by  the  coroner  that  there  were  rumors  that  his 
wife  came  to  her  death  by  foul  means  and  that  some  of  those  rumors 
implicated  him,  and  that  he  was  not  obliged  to  testify  unless  he  chose. 
He  said  he  had  no  objection  to  telling  all  he  knew.  The  Court  in  de- 
livering its  opinion  preludes  it  by  a  reference  to  these  facts  as  showing 
that  the  statements  made  were  voluntary  in  every  legal  sense,  and  held 
that  a  mere  consciousness  of  being  suspected  of  a  crime  did  not  so  dis- 
qualify him  that  his  testimony,  in  other  respects  freely  and  voluntarily 
given  before  the  coroner,  could  not  be  used  against  him  on  his  trial  on 
a  charge  sixbsequently  made  of  such  crime.  On  that  ground  it  held 
the  evidence  properly  admitted,  at  the  same  time  referring  with  ap- 
proval to  the  McMahon  Case,  and  distinctly  limiting  the  rule  of  ex- 
clusion to  cases  within  its  bounds. ' 

Mondon  Case. — Then  followed  the  Mondon  Case,  where  on  the  find- 
ing of  the  body  of  the  deceased,  the  defendant  was  arrested  without  war- 
rant as  the  suspected  murdex^er.  While  he  was  thus  in  custody  the 
coroner  empanelled  a  jury  and  held  an  inquest,  and  the  defendant  was 
called  as  a  witness  before  the  inquest  and  was  examined  by  the  district 
attorney  and  by  the  coroner.  The  prisoner  was  an  ignorant  Italian 
laborer  unfamiliar  with  the  English  language.  He  was  unattended 
by  counsel,  and  it  did  not  appear  that  he  was  in  any  manner  informed 
of  his  rights,  or  that  he  was  not  bound  to  answer  questions  tending  to 
criminate  him.  He  was  twice  examined;  on  the  first  occasion  the  ex- 
amination was  taken  by  questions  put  either  by  the  district  attorney  or 
by  the  coroner,  and  the  result  written  down  by  the  coroner,  who  then 
read  the  evidence  over  to  him,  line  by  line,  and  asked  him  if  he  under- 
stood it  and  if  it  was  the  truth,  and  he  said  it  was,  and  the  coroner  then 
reswore  him  to  the  deposition.  The  coroner,  after  taking  the  de- 
fendant's testimony  on  the  first  day,  came  to  the  conclusion  that  the 
defendant  did  not  understand  English  well  enough  to  be  examined, 
and  that  it  ought  to  be  taken  through  an  interpreter,  which  was  done, 
in  order  that  they  might  get  it  a  little  better  and  a  little  fuller.  It  was 
held  that  the  defendant's  testimony  was  not  admissible  upon  his  trial 
on  the  indictment.^  It  will  be  seen  that  this  latter  case  follows  in  direct 
line  with  the  rule  announced  in  the  McMahon  Case  and  clearly  dis- 
tinguishes another  case,  the  McGloin  Case,  u])()n  the  authority  of  which 
the  trial  court  held  the  testimony  of  the  prisoner  in  the  Mondon  Case 
admissible. 

McGloin  Case. — The  case  of  McGloin  was  not  that  of  the  examina- 
tion of  a  prisoner  on  oath  before  a  magistrate  before  whom  he  was  taken 
involuntarily,  while  in  custody,  and  interrogated  by  the  magistrate, 
who  to  all  appearance  had  ])ower  to  require  him  to  answer,  but  wliile 
under  arrest  the  prisoner  said  to  the  inspector  of  police  who  had  him 
in  charge  that  he  would  make  a  statement.     The  inspector  then  said 

'  Teachout  v.  People,  41  N.  Y.,  7.        '^People  v.  Mondon,  103  N.  Y.,  211. 


348  POWERS   AND    DUTIES   OF  CORONERS — BECKER. 

that  he  would  send  for  a  coroner  to  take  it.  The  coroner  was  then  sent 
for  and  came  to  poUce  headquarters  and  took  down  in  writing  the  con- 
fession dictated  by  the  prisoner,  the  coroner  asking  no  questions  and 
not  acting  in  any  official  capacity,  but  as  a  mere  amanuensis  to  take 
down  the  confession  and  prove  the  contents.  It  was  held  that  the  con- 
fession of  the  prisoner  was  admissible  in  evidence  upon  his  trial  for 
murder. ' 

Rule  in  Pennsylvania. — The  rule  in  Pennsylvania  is  sub- 
stantially that  when  the  testimony  given  by  the  prisoner  under 
oath  before  a  coroner's  inquest,  previous  to  him  being  charged 
or  suspected  of  the  murder  of  the  individual  upon  whose  body 
the  inquest  was  sitting,  may  afterward  be  given  in  evidence 
against  him,  on  his  trial  for  the  murder  of  such  person.^ 

Rule  in  Nebraska. — The  statements  of  a  prisoner  to  be  com- 
petent evidence  must  have  been  voluntarily  made.  In  cases  of 
declaration  made  on  an  examination  before  a  coroner's  inquest 
by  a  person  under  arrest  or  charged  vsrith  the  crime  and  also 
under  oath,  they  are  not  admissible.  But  when  the  person, 
although  he  be  subsequently  charged  with  the  offence,  appears 
voluntarily,  and  gives  testimony,  before  any  accusation  has 
been  made  against  him,  his  statements  are  admissible  in  evi- 
dence against  him  on  the  trial  of  an  indictment  for  the  crime. ^ 

'  People  V.    McGloin,    91   N.    Y. ,  cused  man  in  entire  silence,  appears 

241.  in  beautiful  contrast  to  the  conti- 

"  Williams  v.  Commonwealth,  29  nental  systems,  which  permit  the 
Pa.  St. ,  102.  In  this  case  the  pros-  criminal  to  be  racked  by  inquisito- 
ecution  was  permitted  to  prove  upon  rial  skill,  until  something  be  wrung 
the  trial  that  a  justice  of  the  peace  from  him  which  maybe  patched  up 
had  held  an  inquest  on  the  body  of  into  proof  of  guilt.  This  case  shows 
a  dead  person,  and  appointed  an-  nothing  of  the  kind.  The  phrase 
other  person  foreman  of  the  inquest,  'called  up'  commented  on  by  the 
and  directed  him  to  swear  wit-  counsel,  does  not  appear  in  the  rec- 
nesses  ;  and  while  the  inquest  was  ord,  and  if  employed  by  the  wit- 
still  sitting,  the  foreman  called  upon  nesses  related  doubtless  to  the  or- 
and  requested  the  defendant  to  be  dinary  case  of  calling  forth  a  wit- 
sworn  and  give  evidence  as  a  wit-  ness,  and  not  awakening  him  from 
ness,  and  he  was  duly  sworn  and  slumber.  When  the  defendant  was 
was  examined  by  the  foreman,  in  sworn  before  the  inquest,  he  had 
presence  of  the  inquest.  It  was  held  neither  been  charged  with  nor  sus- 
on  appeal  that  his  evidence  was  ad-  pected  of  crime.  He  might  have 
missible.  On  this  point  the  Court  declined  to  testify,  and  this  would 
said  :  "  If  the  defendant  had  been  have  pointed  suspicion  directly  to 
awakened  out  of  sleep,  charged  with  him.  He  took  the  risk  of  a  state- 
crime,  and  then,  in  the  necessary  ment,  and  cannot  complain  that  he 
confusion  of  his  faculties  sworn  to  met  the  legitimate  consequences  of 
testif}',  I  should  have  steadfastly  the  act.  In  the  eye  of  all  the  au- 
resisted  the  subsequent  introduction  thorities,  it  was  a  voluntary  state- 
of  the  testimony  against  him.  The  ment. " 
common  law,  which  justifies  an  ac-  ^  Clough  v.  The  State,  7  Neb. ,  320. 


MEDICO-LEGAL  AUTOPSIES. 


BY 

H.  p.  LOOMIS,  A.M.,  M.D., 

Professor  of  Pathology  in  the  University  of  the  City  of  New  York;  Visiting  Physician 

and  Curator  to  Bellevue  Hospital,  New  York;  Pathologist  to  the 

Board  of  Health,  Neiu  York  City;  President  Neio 

York  Pathological  Society,  etc.,  etc. 


AUTOPSIES. 

A  MEDICAL  examiner  before  proceeding  with  an  autopsy, 
especially  if  called  before  the  body  has  been  removed  from  the 
place  where  it  was  found,  should  carefullj'  note  certain  facts. 
These  should  be  entered  by  himself  or  an  assistant  with  great 
care,  in  a  note-book,  as  this  book  can  be  introduced  as  evidence 
in  any  trial.  A  satisfactory  way  is  to  dictate  to  the  assistant 
as  the  examination  proceeds,  and  at  the  conclusion  the  assistant 
reads  the  notes  taken,  and  the  examiner  verifies  them. 

SURROUNDING  OBJECTS— POSITION  OF  THE  BODY. 

These  should  be  first  noted.  The  character  of  the  soil;  the 
condition  of  the  ground,  and  whether  it  shows  footprints ;  if  so, 
their  direction;  the  evidence  of  any  struggle;  the  presence  of 
any  weapon ;  and  finally,  the  exact  position  in  which  the  bod}' 
lies,  especially  the  position  of  the  hands  and  feet.  This  is  im- 
portant, for  the  body  may  be  found  in  a  position  which  the 
deceased  could  not  have  assumed  on  the  supposition  of  the 
wound  or  injury  having  been  accidental  or  homicidal.  If  pos- 
sible a  photograph  should  be  taken  of  the  body  in  the  exact 
position  in  which  it  is  found.  If  it  is  absolutelj'  necessary-  to 
remove  the  body,  it  should  be  done  with  great  care,  keeping  the 
body  in  as  horizontal  a  position  as  possible. 

The  character  of  the  surrounding  soil  should  be  noted.  This 
is  of  special  importance  when  the  body  to  be  examined  has  been 
exhumed :  for  the  question  of  preservation  of  the  bodj^  and  the 
ability  to  recognize  pathological  changes  may  be  brought  up  at 
a  trial.  This  was  an  important  point  raised  in  the  Buchanan 
case  (New  York,  1893). 

If  a  body  be  found  in  the  water,  examine  the  character  of 
the  water  and  the  temperature,  and  if  found  near  the  shore,  the 
character  of  shore  and  bottom. 

Blood. — The  situation  of  blood-stains,  and  their  mmiber 
and  extent,  on  clothing  or  surrounding  objects  should  be  noted. 


352  MEDICO-LEGAL  AUTOPSIES — LOOMIS. 

This  will  often  show  whether  a  struggle  has  taken  place  after 
receiving  the  fatal  wound,  and  is  also  of  medico-legal  impor- 
tance if  made  at  the  time  the  body  is  found,  for  it  may  be  so 
situated  as  to  show  that  the  bod}*  has  been  interfered  with 
after  death. 

Again,  spots  of  blood  found  upon  articles  of  clothing  or 
upon  surrounding  objects  should  be  noted  as  to  their  form  and 
direction,  for  they  may  serve  to  furnish  an  indication  of  the 
position  of  the  person  with  respect  to  them  when  the  wound 
was  inflicted.  For  example,  if  the  spot  was  oval,  the  presump- 
tion is  that  the  person  was  placed  obliquely  with  respect  to  the 
stain  while  the  hemorrhage  was  occurring.  The  force  with 
which  the  blood  was  thrown  out  will  in  some  measure  be  indi- 
cated by  the  obliquity  or  length  of  the  spot.  The  amount  of 
blood  will  also  often  indicate  whether  the  person  has  died  sud- 
denly, the  exact  spot  where  death  occurred,  whether  a  struggle 
took  place,  and  will  also  preclude  the  possibility  of  a  person 
moving  after  receiving  the  fatal  injur3^  When  we  examine  a 
body,  especially  when  found  in  a  room,  care  must  be  taken  not 
to  be  misled  by  the  accidental  diffusion  of  blood  by  persons 
going  in  and  out,  or  touching  the  body  (see  Bood-Stains,  Vol. 

n.). 

Clo thing. — The  examination  of  the  clothing  should  be 
thorough.  A  description  of  each  article  should  be  noted,  and 
the  order  in  which  it  is  removed ;  for  often  it  is  important  to 
prove  that  the  garments  were  worn  by  or  belonged  to  the  de- 
ceased. If  any  blood  is  on  the  clothing,  note  whether  the  blood 
is  in  large  patches,  or  whether  it  is  sprinkled  over  the  garment : 
the  amount  of  the  blood  and  what  garments  are  stained  by  it. 
Note  and  examine  whether  the  blood  has  flowed  down  the  front 
of  the  clothing,  whether  it  has  soaked  the  inner  garments,  or 
agaip,  whether  it  has  collected  along  the  back;  for  these  ap- 
pearances will  sometimes  demonstrate  whether  a  wound  was 
inflicted  while  the  person  was  sitting,  standing,  or  lying  down. 
For  example,  if  the  throat  is  cut  while  the  person  is  lying 
down,  the  blood  will  be  found  on  each  side  of  the  neck  along 
the  back  and  not  down  the  front  of  the  body.  Few  suicides  cut 
their  throats  in  a  recumbent  position,  and  this  distribution  of 
the  blood  may  serve  to  distinguish  a  suicidal  from  a  homicidal 
wound. 


WEAPONS.  353 

The  condition  of  the  clothing  may  also  serve  to  show 
whether  there  has  been  any  struggle,  and  the  presence  of  dry 
spots  or  mud  on  it  may  sometimes  serve  to  connect  an  accused 
person  with  an  act  of  murder.  This  is  well  illustrated  in  the 
case  of  Reg.  v.  Snipe,  reported  in  Beck's  "  Medical  Jurispru- 
dence," where  evidence  was  adduced  to  show  that  some  spots  of 
mud  on  the  boots  and  clothing  of  the  prisoner,  when  examined 
microscopically,  contained  infusoria,  shells,  and  some  rare 
aquatic  vegetables.  The  mud  of  the  ditch  close  to  where  the 
body  was  found,  as  also  the  mud  on  the  clothing  of  the  dead 
body,  presented  the  same  microscopical  appearances.  The  med- 
ical expert  who  gave  this  evidence  swore  that  in  his  opinion 
the  mud  spots  on  the  body  and  on  the  prisoner's  boots  were 
derived  from  the  same  ditch,  for  the  mud  of  all  the  other  ditches 
in  the  locality  was  found,  on  microscopical  examination,  to  be 
different.  The  well-known  case  which  occurred  in  New  York 
a  few  years  ago,  known  as  the  "Shakespeare  case,"  furnishes 
an  example  of  the  importance  of  carefully  examining  all  stains 
on  the  clothing  found  on  bodies. 

If  there  are  several  stabs  or  cuts  on  the  body  involving  the 
dress,  it  should  be  noted  whether  they  are  blood-stained,  and  if 
so,  whether  the  stain  is  on  the  inside  or  outside  of  the  garments, 
for  sometimes  in  simulated  personal  injury  a  stain  of  blood  may 
be  inadvertently  applied  to  the  outside  of  the  dress,  as  in  wip- 
ing a  weapon. 

Weapons. — If  a  weapon  is  found,  the  character  of  the 
weapon  and  its  exact  position  should  be  noted.  This  is  fre- 
quently of  importance  in  telling  whether  a  person  has  died  from 
an  accidental  or  self-inflicted  wound.  In  a  case  whore  death 
occurs  immediately  or  within  a  few  minutes,  the  weapon  is 
found  near  the  body,  or  often  so  tightl}^  grasped  in  the  hand 
that  it  can  be  with  difficulty  removed.  If  the  weapon  is  found 
near  the  body  it  should  be  noted  on  which  side  and  at  what 
distance,  and  it  must  be  questioned  whether  it  could  have  fallen 
on  the  spot  or  been  thrown  there  by  the  deceased.  It  is  com- 
patible with  suicide  that  the  weapon  should  be  found  at  some 
distance  from  the  body.  An  instance  has  been  recorded  where 
an  individual  was  discovered  in  bed  with  his  throat  cut,  and 
the  bloody  razor  was  found  closed  and  in  the  pocket  of  the 
deceased.  If  a  weapon  cannot  be  discovered,  or  is  concealed, 
23 


354  MEDICO-LEGAL   AUTOPSIES — LOOMIS. 

it  is  strong  presumptive  evidence  of  homicide ;  especially  when 
the  wound  is  such  as  to  produce  speedy  death. 

Note  whether  the  weapon  is  sharp  or  blunt,  straight  or 
curved.  If  a  knife,  the  handle  and  inner  portion  should  be  ex- 
amined, for  the  blade  ma}^  have  been  washed. 

If  the  wound  has  involved  any  large  vessels,  it  is  improbable 
that  the  weapon  can  have  been  thrown  any  distance  from  the 
body,  and  when  it  is,  there  are  always  fair  grounds  to  expect 
interference  with  the  original  position  of  the  body.  One  cir- 
cumstance which  always  strongly  points  to  suicide  is  the  find- 
ing of  the  weapon  firmly  grasped  in  the  hand  of  the  cadaver. 
The  hand  of  a  dead  person  cannot  be  made  to  grasp  or  retain  a 
weapon  as  does  the  hand  which  has  grasped  it  at  the  last  mo- 
ments of  life.  The  amount  of  blood  on  the  weapon  should  be 
noted,  but  it  must  be  remembered  that  a  knife  may  have  pro- 
duced a  fatal  stab  wound  and  still  no  blood  be  found  on  it. 
This  is  explained  by  the  fact  that  in  a  rapid  plunge  the  vessels 
were  compressed,  and  only  after  the  drawing  of  the  knife  and 
relieving  of  the  pressure  blood  began  to  flow,  or  possibly  the 
blood  may  have  been  wiped  off  the  knife  by  the  elasticity  of  the 
skin. 

When  a  person  has  died  of  a  gunshot  wound,  especially  at 
close  range,  it  is  important  to  look  for  any  wadding  or  paper 
found  in  the  wound,  as  in  a  number  of  instances  the  finding 
of  such  has  led  to  the  detection  of  the  criminal.  For  example, 
handwriting  has  been  found  on  the  paper,  or  it  has  formed 
part  of  a  printed  page  the  rest  of  which  has  been  found  in  pos- 
session of  the  accused.  When  a  gun  is  discharged  near  the 
body,  a  portion  of  the  wadding  is  almost  always  found  in  the 
irregular  wound  produced. 

POST-MORTEM  EXAMINATION. 

Having  completed  the  examination  of  the  surroundings,  one 
next  proceeds  with  the  post-mortem  examination,  which  should 
be  conducted  according  to  a  well-defined  plan,  following  which 
the  results  obtained  will  always  be  satisfactory. 

If  possible  the  body  should  be  removed  to  a  large,  well- 
ventilated,  and  especially  well-lighted  room.  No  artificial  light, 
if  it  can  possibly  be  avoided,  should  be  used  when  performing 


POST-MORTEM   WOUNDS.  355 

the  autopsy ;  artificial  light  is  especially  bad  on  account  of  its 
yellowness  and  its  power  to  modify  natural  color.  Many  dis- 
eased conditions  cannot  be  satisfactorily  determined  by  artificial 
light.  The  bod}^  should  be  placed  on  a  high  table,  and  the 
facility  with  which  the  autopsy  is  made  will  often  depend  on 
having  the  table  high  enough  to  render  stooping  unnecessary. 
Never  make  an  autopsy,  if  it  can  possibly  be  avoided,  on  a 
body  while  in  a  coffin,  as  the  examination  is  always  unsatisfac- 
tory. The  size  and  surroundings  of  the  room,  and  how  it  is 
lighted,  should  be  entered  in  the  note-book. 

Instruments. — If  possible  the  following  instruments  should 
be  at  hand  before  proceeding  with  an  examination,  although 
some  of  them  may  be  dispensed  with : 

(1)  Large  section  knife;  (2)  scalpels;  (3)  enterotome  (for 
opening  intestines  and  stomach) ;  (4)  costotome,  or  large  bone 
forceps  (for  cutting  ribs) ;  (5)  scissors,  large  and  small  (one 
blade  blunt);  (G)  saw;  (7)  chisel;  (8)  dissecting  forceps;  (9) 
probe;  (10)  blowpipe;  (11)  curved  needles  and  strong  twine; 
(12)  measuring  and  graduated  glass;  (13)  small  scales. 

Besides  the  above  instruments,  some  basins  containing 
water;  sponges,  bottle  of  flexible  collodion,  Lugol's  solution  of 
iodine  for  the  amyloid  test,  will  be  needed. 

Post-Mortem  Wounds. — Various  plans  have  been  pro- 
posed to  protect  the  operator's  hands  from  the  post-mortem 
wounds  which  are  often  so  dangerous,  such  as  wearing  rubber 
gloves,  smearing  the  hands  with  carbolized  vaselin,  both  of 
which  have  their  disadvantages :  the  gloves  being  too  clumsy, 
and  the  vaselin  rendering  it  almost  impossible  to  hold  the  knife 
steady.  Gloves  should  always  be  worn,  however,  where  the 
body  has  undergone  much  decomposition,  or  where  the  person 
may  have  died  from  any  septic  disease.  A  method  which  I 
have  found  satisfactorj^  is  to  cover  all  cuts  and  hangnails  with 
flexible  collodion,  and  then  to  have  a  basin  of  clean  water  at 
hand,  and  from  time  to  tiAie  to  rinse  one's  hands  in  the  water. 
It  is  from  bathing  the  hands  in  the  cadaveric  fluids  and  not 
from  cuts  that  most  of  the  danger  comes.  If  possible  an  abso- 
lutely new  board,  large  enough  upon  which  to  examine  the 
organs,  should  be  at  hand,  for  it  ma}'  be  claimed  at  a  trial  that 
the  organs  and  tissues,  if  placed  and  examined  on  surrounding 
objects,  have  become  contaminated. 


356  MEDICO-LEGAL   AUTOPSIES — LOOMIS. 

Toxicological. — If  a  chemical  analysis  of  the  various 
organs  and  tissues  is  to  be  made,  and  it  is  impossible  to  liave 
the  chemist  present,  the  medical  examiner  should  obtain  some 
new  glass  jars  of  suitable  size,  with  close-fitting  glass  covers. 
These  jars  shoud  be  rinsed  with  distilled  water,  and  in  them  the 
various  organs  are  to  be  placed ;  if  possible  with  no  preserving 
fluid  on  them.  But  if  it  is  found  impossible  to  deliver  the  jars 
to  the  chemist  at  once,  alcohol  may  be  poured  over  the  organs 
in  the  jars,  but  it  is  specially  important  that  a  sample  of  this 
alcohol  should  be  retained,  that  a  chemist  may  at  a  future  date 
test  the  same  for  any  impurities.  After  the  organs  and  tissues 
have  been  placed  in  the  jars,  the  mouths  should  be  closed  and 
sealed,  and  the  seal  remain  in  the  custod}^  of  the  examiner  until 
the  jars  are  delivered  to  the  chemist. 

Parts  to  be  Preserved  for  the  Chemist. — In  cases  of 
suspected  poisoning,  it  is  not  sufficient  that  the  stomach  and 
intestines  alone  should  bo  preserved  for  the  chemist  as  has  been 
indicated,  each  part  by  itself;  for  it  should  be  remembered  that 
the  portion  of  poison  remaining  in  the  alimentary  tract  is  but 
the  residue  of  the  dose  which  had  been  sufficient  to  destroy  life, 
and  if  the  processes  of  elimination  have  been  rapid  no  trace  of 
the  poison  will  be  found  in  the  alimentary  canal  but  can  readily 
be  detected  in  other  organs.  Again,  the  poison  may  not  have 
been  introduced  by  the  mouth,  in  which  case  none  may  be 
found  in  the  digestive  tract. 

The  chemist  should  receive,  besides  the  stomach  and  entire 
intestinal  canal,  the  liver,  one  or  both  kidne3'S,  the  spleen,  a 
piece  of  muscle  from  the  leg,  the  brain,  and  any  urine  found  in 
the  bladder. 

When  it  is  impossible  for  any  reason  to  obtain  the  whole  of 
any  organ,  the  part  removed  should  be  carefully  weighed  and 
its  proportion  to  the  rest  of  the  organ  noted. 

It  is  also  of  extreme  importance  to  preserve  in  sealed  and 
labelled  jars  those  parts  of  a  bod}''  which  maj'  show  the  evi- 
dence of  disease,  or  on  the  appearance  of  which  one's  evidence 
is  fovmded. 

ORDER  OF  AUTOPSY. 

In  making  the  autopsy,  the  operator  should  stand  on  the 
right  side  of  the  body  and  make  the  incision  by  grasping  the 


ORDER   OF   AUTOPSY.  357 

knife  firmly  in  the  hand,  and  cutting  with  the  whole  of  the 
blade  and  not  with  the  point.  The  knife  should  be  swept  along 
from  the  shoulder  rather  than  from  the  wrist,  thus  making  a 
long,  smooth,  deep  cut ;  never  a  jagged  one. 

The  method  of  examining  the  human  body  after  death  will 
vary  somewhat  according  to  the  objects  in  view.  These  objects 
may  be  threefold:  (1)  To  ascertain  whether  a  person  has  died 
from  violence  or  poison;  (2)  to  establish  the  cause  of  death, 
especially  if  it  has  been  sudden ;  and  (3)  to  ascertain  the  lesion 
of  a  disease,  or  to  confirm  a  diagnosis. 

The  only  difference  between  a  medico-legal  and  pathological 
autopsy  is  that  in  the  former  case  everything  which  might 
subserve  the  ends  of  justice  should  be  carefully  noted,  and  the 
changes  found  most  accurately  described ;  especially  any  abnor- 
malities found  on  the  external  examination  of  the  body.  A 
photograph  should  be  taken  of  the  body. 

The  head  should  be  opened  and  the  brain  examined  first,  and 
not  last,  as  is^  often  done  in  the  ordinary  autopsy. 

Careful  notes  should  be  taken  during  each  step  of  the  exam- 
ination, to  be  reread,  verified,  and  signed  at  the  completion  of 
the  autopsy. 

It  must  be  remembered  that  most  of  the  lesions  of  disease 
which  are  found,  indicate  the  disease  rather  than  the  cause  of 
death ;  that  often  the  lesion  found  will  seem  hardly  extensive 
enough  to  cause  death,  and  that  from  accidents  and  injuries 
apparently  trivial,  death  may  result.  It  must  often  be  acknowl- 
edged that  no  sufficient  cause  of  death  can  be  found,  but  the 
more  accurate  and  careful  the  examinations  (especially  when 
a  microscopical  examination  of  the  organs  is  made)  the  fewer 
will  be  the  number  of  such  cases.  If  no  apparent  lesion  is 
found,  it  must  not  be  forgotten  that  many  poisons  destroy 
life  and  leave  no  trace  that  the  pathologist  can  discover. 

Care  should  always  be  exercised  not  to  mistake  the  ordinary 
post-mortem  appearance  which  we  find  at  autopsies  for  the 
lesions  of  disease. 

The  examination  of  the  human  body,  whether  it  be  made 
from  a  medico-legal  or  pathological  standpoint,  is  divided  into 
two  main  divisions : 

(1)  The  external  examination,  and 

(2)  The  internal  examination. 


358  MEDICO-LEGAL  AUTOPSIES — LOOMIS. 

EXTERNAL   EXAMINATION. 

Its  minuteness  will  depend  on  the  character  of  the  case,  as 
when  the  person  is  unknown,  or  when  suspected  to  have  died 
from  unnatural  causes.  In  such  cases  the  external  examination 
is  very  important. 

The  following  are  the  steps  to  be  followed : 

(1)  Give  a  general  description  of  the  body;  apparent 
age,  height,  and  weight  of  the  individual;  color  of  the  hair  and 
eyes ;  condition  of  the  teeth ;  and  the  evidence  of  any  personal 
peculiarities  or  abnormalities. 

(2)  Note  the  color  of  the  skin  and  observe  whether  there 
are  an}^  spots  of  cadaveric  lividity,  and  if  present  where 
situated. 

(3)  Contusions. — Note  whether  there  are  any  contusions, 
and,  if  present,  their  character,  situation,  length,  breadth,  and 
depth  should  be  described,  and  whether  they  are  accompanied 
by  inflammation  or  by  the  evidences  of  gangrene. 

It  is  often  important  to  determine  whether  a  contusion  has 
been  inflicted  before  or  after  death.  This  is  to  be  done  by  cut- 
ting into  the  ecchymoses  and  if  the  extravasated  blood  or  the 
coloring  matter  of  the  blood  is  found  free  in  the  tissues,  one  can 
be  almost  certain  that  it  is  an  ante-mortem  injury.  In  post- 
mortem discolorations  the  blood  is  found  in  the  congested  ves- 
sels. The  situation  of  ante-mortem  contusions  will  not  gener- 
ally correspond  to  the  discolorations  produced  by  decomposition ; 
the  latter  being  confined  to  the  most  dependent  parts.  It  should 
be  remembered  that  the  contusions  produced  bj^  blows  on  a  body 
dead  onh"  a  few  hours  cannot  be  distinguished  from  those 
which  were  received  during  life;  and  also  that  putrefactive 
changes  make  it  well-nigh  impossible  to  distinguish  between 
ante-mortem  and  post-mortem  injuries.  It  should  also  be  borne 
in  mind  that  blows  or  falls  sufficient  to  fracture  bones  or  rup- 
ture organs  may  leave  no  mark  on  the  skin  (see  Wounds,  Vol. 
I.,  pp.  467,  4T4,  et  seq.). 

(4)  Wounds. — The  situation,  depth,  extent,  and  direction  of 
any  wound  should  be  recorded,  as  also  the  condition  of  its  edges ; 
the  changes  in  the  surrounding  tissues,  and  whether  inflicted 
by  a  cutting,  pointed,  or  rounded  instrument ;  or  by  a  bullet. 
In  the  latter  case  the  course  and  direction  of  the  ball  should  be 


EXTERNAL   EXAMINATION.  359 

ascertained  by  dissection  rather  than  by^  the  use  of  the  probe, 
and  the  character  of  foreign  bodies,  if  an}'  are  found  in  the 
wound,  should  be  noted.  What  nerves  or  blood-vessels,  partic- 
ularly arteries,  have  been  injured,  should  be  ascertained.  It  is 
often  important  to  determine  whether  a  wound  was  made  before 
or  after  death.  The  following  may  serve  as  a  differential  point : 
In  all  wounds  made  after  death  there  is  slight  bleeding,  non-con- 
traction of  the  edges,  and  absence  of  blood  in  the  tissues.  This 
is  the  opposite  of  ante-mortem  wounds.  Again,  wounds  inflicted 
within  two  hours  after  death  cannot  be  differentiated  from 
those  made  during  life  (see  Gunshot  Wounds,  Vol.  I.,  p. 
GIO  et  seq.j  Wounds,  Vol.  I.,  p.  476  et  seq.). 

(5)  Fractures. — If  there  are  any  evidences  of  fractures,  the 
situation  of  the  bones  involved  should  be  noted,  and  whether 
they  are  accompanied  by  contusions  of  the  soft  parts.  Frac- 
tures which  are  inflicted  during  life  are  always  accompanied 
by  much  more  extravasation  of  blood,  more  injury  to  the  soft 
parts,  and  more  evidences  of  reaction  than  those  occurring  after 
death.  It  is  a  well-known  fact  that  it  is  much  more  difficult  to 
produce  a  fracture  in  a  dead  than  a  living  body  (see  Wounds, 
Vol.  II.,  p.  482  et  seq.). 

(6)  The  temperature  of  the  body  should  be  taken, 

(7)  The  rigidity  and  flexibility  of  the  extremities 
should  be  ascertained. 

(8)  The  state  of  the  eyes  should  be  noticed,  and  the  rela- 
tive size  of  the  pupils. 

(9)  Attention  should  be  paid  to  the  condition  of  the  cavities 
of  the  mouth  and  nose.  The  neck  should  be  speciall}'  examined 
for  marks  of  external  injury,  or  signs  of  ecchymosis  or  com- 
pression. 

(10)  Genitals, — The  external  genitals  should  be  very  care- 
fully examined  for  evidence  of  injury,  the  presence  of  sj'philitic 
lesions,  and  in  the  female  the  condition  of  the  vagina  should  be 
particularly  ascertained. 

(11)  (Edema  of  the  Feet. — If  there  is  evidence  of  oedema 
in  any  part  of  the  body,  especiallj"  about  the  ankles,  its  situa- 
tion and  extent  should  be  noted. 

(12)  Ulcers  and  Abscesses.— The  situation  and  extent  of 
any  ulcer  found  on  the  body  should  be  recorded,  as  also  the  pres- 
ence and  situation  of  any  abscess. 


360  MEDICO-LEGAL   AUTOPSIES — LOOMIS. 

(i;})  Burns. — The  ^extent  of  a  burn,  as  also  the  state  of  the 
parts  involved,  should  be  noted.  For  example,  whether  they 
are  inflamed  or  show  blisters,  etc.  (see  Heat  and  Cold,  Vol. 
I.,  p.  G47  et  seq.). 

(14)  Hands. — In  medico-legal  cases  the  hands  of  a  dead 
person  should  always  be  examined  for  the  presence  of  cuts, 
excoriations,  or  foreign  substances  found  upon  them ;  especially 
should  the  dorsal  extremities  be  examined.  This  examination 
will  often  indicate  that  there  has  been  a  mortal  struggle  before 
death.  The  impression  of  a  hand  or  of  some  of  the  fingers  is 
often  found  on  the  skin  of  a  dead  bod}".  The  exact  situation 
where  found  should  be  noted.  This  may  be  of  importance,  as 
when  it  occurs  where  it  would  have  been  impossible  or  improb- 
able for  the  deceased  to  have  caused  it. 

For  appearances  in  death  from  lightning  or  electricity,  see 
Vol.  I.,  p.  701  et  seq.,  and  in  death  from  hanging,  strangula- 
tion, and  garroting,  see  Vol.  I.,  pp.  713,  746,  781,  et  seq. 

INTERNAL  EXAMINATION. 

Having  completed  the  examination  of  the  external  parts  of 
the  body,  the  next  proceeding  is  to  open  the  body  and  make  an 
internal  examination. 

This  should  be  done  by  following  a  regular  method,  so  as  to 
examine  the  relations  of  parts  and  not  to  injure  one  organ  while 
removing  another. 

In  opening  the  various  organs  an  incision  should  be  made 
which  will  expose  the  greatest  amount  of  surface  at  one  cut. 
Never  make  a  number  of  small  and  alwaj's  unsatisfactory  inci- 
sions in  an  organ.  In  opening  certain  organs  like  the  brain 
and  heart,  the  incisions  are  so  planned  that  the  parts  of  the 
organ  may  be  folded  together,  and,  if  necessary,  their  relations 
to  one  another  and  the  whole  organ  studied.  Such  organs  are 
opened  as  one  would  open  a  book  to  examine  its  pages. 

It  is  important  to  remember  that  after  death  the  blood  leaves 
the  arteries  and  left  side  of  the  heart,  and  collects  in  the  veins 
and  the  right  cavities  of  the  heart.  Especially  does  it  collect 
in  the  vessels  of  the  most  dependent  portions  of  the  bod}'  and 
of  the  various  organs,  so  that  local  congestions  may  often  dis- 
appear after    death;   and  again,  they  may    be    found    at    an 


THE    HEAD.  361 

autopsy  where  they  were  not  present  during  life.  Especially  is 
this  true  of  the  mucous  membranes  such  as  those  of  the  trachea 
and  bronchi,  and  also  of  the  blood  in  the  sinuses  of  the  dura 
mater. 

In  making  autopsies  it  is  a  cardinal  rule  that  all  the  cavities 
of  the  body  should  be  examined,  and  not  alone  the  one  where 
one  might  expect  to  find  a  lesion.  At  medico-legal  autopsies, 
the  great  cavities — the  head,  the  thorax,  and  the  abdomen — 
should  be  examined  in  their  successive  order  from  above  down- 
ward. The  reason  for  beginning  with  the  head  is  that  the 
amount  of  blood  in  the  brain  and  its  membranes  may  be  deter- 
mined accurately ;  for,  if  the  heart  and  great  vessels  of  the  neck 
are  opened  first,  the  blood  will  drain  away  from  the  brain  and 
local  congestions  disappear.  In  pathological  autopsies,  the 
opening  of  the  head  first  is  not  so  important,  and  often  the 
vertebral  column  need  not  be  opened  at  all,  for  it  is  a  compli- 
cated process  and  takes  time;  but  in  medico-legal  cases,  espe- 
cially where  a  question  as  to  the  cause  of  death  may  arise,  and 
has  not  satisfactorily  been  determined,  after  all  the  other  cav- 
ities are  examined  the  vertebral  column  should  always  be  opened 
and  the  cord  removed. 

The  Head. 

Make  an  incision  across  the  vertex  of  the  skull  from  ear  to 
ear.  Dissect  the  anterior  flap  forward  until  within  about  three 
inches  of  the  bridge  of  the  nose,  and  the  posterior  flap  back- 
ward to  the  external  occipital  protuberance.  Examine  the  in- 
ternal surface  of  the  scalp  for  ecchymosis  and  evidences  of  in- 
jury. A  circular  incision  is  then  made  with  a  saw  through  the 
cranium  as  far  backward  and  forward  as  the  flaps  have  been 
reflected.  An  incision  through  the  temporal  muscle  is  neces- 
sary so  that  the  teeth  of  the  saw  may  not  become  clogged  by 
the  muscle  fibres.  When  the  cranium  has  been  sawed  through, 
a  stout  hook  is  inserted  under  its  upper  edge  and  it  is  removed 
with  a  quick  jerk.  If  the  dura  mater  is  verj'  adherent  to  the 
calvaria,  it  may  be  necessary  to  remove  it  with  the  bone,  by 
cutting  through  it  at  the  level  of  the  cranial  incision.  Exam- 
ine the  calvaria  as  also  the  other  bones  of  the  skull  after  the 
brain  has  been  removed  and  the  dura  stripped  off,  for  evidence 
of  fracture. 


362  MEDICO-LEGAL  AUTOPSIES— LOOMIS. 

Note  the  symmetry,  thickness,  and  density  of  the  cranial 
bone,  and  remember  that  depressions  along  the  sagittal  suture 
are  for  the  Pacchionian  bodies,  and  are  not  pathological. 

Dura  Mater. — The  dura  mater  may  be  slightly  adherent 
to  the  bone  of  the  cranium.  This  is  especially  seen  in  old 
people  and  does  not  indicate  disease.  The  Pacchionian  bodies 
are  seen  along  the  longitudinal  sinus.  Examine  the  internal 
surface  of  the  dura  mater  for  the  presence  of  clots,  tumors,  or 
inflammatory  lesions.  Open  the  longitudinal  sinus  and  exam- 
ine for  thrombi.  Remove  the  dura  mater  by  an  incision  fol- 
lowing the  cranial  incision,  the  falx  cerebri  between  the  an- 
terior lobes  being  drawn  back  and  divided.  Note  whether  the 
dura  mater  is  adherent  to  the  pia  mater,  and  the  condition  of 
its  internal  surface. 

Pia  Mater. — The  brain,  covered  by  the  pia  mater,  is  now 
exposed.  Note  the  degree  of  congestion  of  the  membrane,  its 
adherence,  and  the  existence  of  pus,  blood,  or  serum  on  its  sur- 
face or  in  its  meshes.  Remember  that  a  considerable  amount 
of  serum  may  be  present  within  normal  limits,  especially  in 
cachectic  subjects,  without  indicating  disease,  but  when  the 
serum  is  so  extensive  as  to  raise  the  pia  mater  and  to  depress 
the  convolutions,  we  have  a  pathological  amount  which  may  be 
a  simple  dropsy  due  to  some  general  cause,  or  the  result  of  a 
chronic  meningitis.  Enough  serous  effusion  in  the  pia  mater 
to  produce  a  condition  which  has  been  called  by  some  writers 
"  serous  apoplexy, "  I  believe  never  occurs  as  a  primary  con- 
dition. 

Loss  of  transparency  and  thickening  of  the  pia  mater,  espe- 
cially along  the  longitudinal  fissure,  is  often  seen  in  old  people 
and  does  not  indicate  disease. 

Brain. — Remove  the  brain  by  raising  the  anterior  lobes  with 
the  fingers  of  the  left  hand  and  cutting  through  the  nerves, 
vessels,  and  the  tentorium  as  they  appear.  The  medulla  is 
cut  as  low  down  as  possible,  and  the  brain  as  it  rolls  out  is 
caught  in  the  left  hand. 

After  being  placed  on  a  clean  board  or  in  a  large  clean  dish, 
it  is  minutel}'  examined.  The  average  weight  of  an  adult  male 
brain  is  forty-nine  and  one-half  ounces;  of  the  female,  forty- 
four  ounces.  Its  proportional  weight  to  that  of  the  rest  of  the 
body  is  as  1  to  45. 


BRAIX.  363 

Lay  the  brain  first  upon  its  convex  surface  and  examine  the  ar- 
teries at  the  base  for  atlieroma,  thrombi,  emboli,  and  aneurisms. 
Examine  the  pia  mater  of  the  base,  especially  for  the  evidences 
of  hemorrhage,  tumors,  tubercles,  and  inflammatory  lesions. 
Next  turn  the  brain  over  on  its  base,  and  proceed  to  open  its 
various  cavities  and  examine  its  internal  structure.  Separate 
the  two  halves  of  the  cerebrum,  until  the  corpus  callosum  is 
exposed.  Make  an  incision  downward  and  outward  at  the 
junction  of  the  corpus  callosum  with  the  cerebrum,  and  the  roof 
of  the  lateral  ventricles  will  be  cut  through  and  their  cavities 
exposed.  Prolong  the  incision  forward  and  backward  so  as  to 
expose  the  cornua.  The  size  and  contents  of  the  ventricles 
should  be  noted,  as  also  the  condition  of  the  epend3^ma.  The 
floor  of  the  lateral  ventricles  being  the  most  frequent  spot  of 
hemorrhage,  if  one  is  found  its  extent  and  the  parts  involved 
by  it  should  be  noted;  especially  its  relation  to  the  internal 
capsule. 

Transverse  incisions  (about  one-sixteenth  of  an  inch  apart) 
are  made  through  the  ganglia  seen  on  the  floor  of  the  lateral  ven- 
tricles. Thus  any  lesions  in  the  substance  of  the  ganglia  will 
be  disclosed.  Three  or  four  longitudinal  incisions  are  now 
made  outward  into  the  hemispheres  nearly  to  the  pia  mater. 
These  will  divide  the  hemispheres  into  long,  prism-shaped 
pieces  held  together  by  the  pia  mater  and  a  little  of  the  cortex, 
thus  enabling  the  brain  afterward  to  be  folded  together,  and  the 
relations  of  lesions  to  the  brain  as  a  whole  studied.  The  third 
ventricle  is  now  exainined  by  cutting  through  the  fornix  and 
corpus  callosum  at  the  foramen  of  Monroe.  Next,  the  fourth 
ventricle  is  opened  by  a  longitudinal  incision  through  the  lower 
portion  of  the  vermiform  process ;  its  contents,  the  condition  of 
its  vessels  and  ependyma  noted.  Then  the  floor  of  the  fourth 
ventricle  is  divided  by  transverse  incisions  one-sixteenth  of  an 
inch  apart,  and  careful  examination  made  for  the  presence  of 
minute  hemorrhages:  for  here  is  a  place  in  the  body  where 
almost  a  microscopical  lesion  (hemorrhage)  may  cause  sudden 
death.  Each  hemisphere  of  the  cerebellum  is  now  opened  by  a 
number  of  incisions  starting  from  the  fourth  ventricle  and 
passing  outward  into  its  substance.  The  presence  of  an}^  tumors 
or  hemorrhage  in  the  cerebellum  will  now  be  recognized. 

In  opening  the  brain,  when  clots,  areas  of  softening,  tumors, 


364  MEDICO-LEGAL   AUTOPSIES — LOOMIS. 

etc.,  are  discovered,  their  exact  location  in  relation  to  surround- 
ing parts  should  be  noted  and  the  blood-vessels  examined  for 
areas  of  degeneration  or  aneurism.  This  examination  can  be 
facilitated  by  allowing  a  stream  of  water  to  flow  over  the  affected 
part.  This  will  wash  out  the  affected  area  and  allow  the  ves- 
sels to  appear. 

Eye. — In  rare  cases  it  may  be  necessary  to  remove  the  eye. 
This  can  be  done  by  breaking  through  the  roof  of  the  orbit 
with  a  saw  or  chisel  and  dissecting  away  the  muscles  so  as  to 
expose  the  optic  nerve  and  the  posterior  portion  of  the  organ. 

Thorax  and  Abdomen. 

The  body  being  placed  on  its  back,  and  the  operator  stand- 
ing on  the  right  side,  an  incision  is  made  through  the  skin, 
fascia,  and  muscles  from  the  top  of  the  sternum  to  the  pubic 
bone,  passing  to  the  left  of  the  umbilicus  and  dividing  every- 
thing down  to  the  sternum  and  the  subperitoneal  tissue.  A 
small  incision  is  now  made  through  the  peritoneum  below  the 
ensiform  cartilage.  Into  this  opening  two  fingers  of  the  left 
hand  are  inserted,  and  by  spreading  the  fingers  and  holding  the 
knife  horizontally  the  peritoneum  can  be  divided  to  the  pubes 
without  injuring  the  intestines.  The  skin  and  muscles  are  now 
dissected  from  the  chest  as  far  back  as  the  false  ribs.  This 
dissection  may  be  facilitated  by  keeping  the  skin  and  muscles 
on  the  stretch  and  cutting  with  the  flat  part  of  the  knife.  In 
order  to  better  expose  the  abdominal  cavity,  the  recti  muscles 
are  divided  beneath  the  skin  at  their  insertion  in  the  pubic 
bone.  Examine  the  cut  surface  of  the  chest  and  abdominal 
muscles,  and  note  their  color,  amount,  and  consistency.  Ob- 
serve whether  the  chest  muscles  show  the  evidence  of  any  para- 
sitic disease  such  as  trichinosis.  The  mammarj-  glands  are 
now  examined  from  behind  and  opened  if  necessary. 

Superficial  Examination  of  Abdominal  Cavity. — 
This  should  be  done  before  opening  the  chest  cavity,  because 
the  position  of  organs  may  become  modified,  and  blood  and 
other  fluids  are  liable  to  find  their  way  from  one  cavity  into 
another;  and  again,  the  blood  in  the  presenting  portion  of  the 
abdominal  organs  will  change  its  color  after  exposure  to  the  air. 

Note  the  Following  Points  :  (a)  The  relative  position 
and  general  condition  of  the  abdominal  organs. 


THORAX.  365 

(b)  The  color  and  amount  of  blood  in  the  presenting  parts. 

(c)  Whether  there  are  any  signs  of  injlammation  or  the 
evidence  of  foreign  bodies  or  tumors. 

(d)  Examine  the  vermiform  appendix. 

(e)  The  amount  of  fluid  in  the  abdominal  cavity.  Nor- 
mally a  small  quantity  of  reddish  serum  will  be  found,  partic- 
ularly in  warm  weather,  at  the  most  dependent  portion  of  the 
abdominal  cavity.  If  the  quantity  is  small  it  can  onl}-  be  as- 
certained b}'  raising  the  intestines  from  the  pelvis.  When  the 
fluid  is  considerable,  the  exact  amount  should  be  ascertained 
and  its  character  noted. 

(/)  Perforation,  invagination,  and  hernia  of  the  intestines 
should  be  looked  for. 

[g)  Determine  the  height  of  the  diaphragm.  Normall}-,  on 
the  right  side,  it  is  at  the  junction  of  the  fifth  rib  with  the 
sternum,  and  on  the  left  it  reaches  as  high  as  the  sixth.  A 
variety  of  pathological  conditions  change  its  position.  For 
instance,  it  may  be  raised  when  the  contents  of  the  abdomen 
are  greath^  increased  in  volume,  and  in  new-born  children  who 
have  never  breathed.  It  maj^  be  depressed  by  enlargement  of 
the  lungs,  disease  of  the  heart,  or  fluid  in  the  pleural  or  peri- 
cardial cavities.  The  presence  of  air  or  gas  in  the  pleural 
cavity  can  be  determined  either  by  filling  the  abdomen  with 
water  and  puncturing  the  diaphragm  beneath  the  fluid  so  that 
the  air  will  bubble  up,  or  a  puncture  may  be  made  through  the 
thorax  between  the  ribs,  and  the  flame  of  a  match  will  be  de- 
flected by  the  escaping  air. 

Thorax. 

The  thorax  is  opened  by  cutting  the  sterno-costal  cartilages 
as  close  to  the  end  of  the  ribs  as  possible,  the  cut  being  made 
downward,  outward,  and  backward,  and  the  knife  held  obliquely 
so  as  not  to  injure  the  underlying  parts.  Quite  often  the  carti- 
lages will  be  found  ossified  and  it  will  be  necessary  to  divide 
them  by  a  costotome.  Next,  separate  the  clavicles  by  a  semi- 
lunar incision  at  their  attachment  to  the  sternum. 

Raise  the  sternum  with  the  left  hand  and  separate  it  from 
the  underlying  parts.  If  there  is  any  adherence  of  the  sternum 
a  slight  twist  will  be  sufficient  to  remove  it. 


366  MEDICO-LEGAL  AUTOPSIES— LOOMIS. 

Superficial  Examination  of  Thorax. — Observe  the 
position,  color,  and  degree  of  distention  of  the  lungs.  It  should 
be  remembered  that  healthy  lungs,  as  soon  as  the  chest  is 
opened,  owing  to  their  inherent  elasticity,  will  collapse,  and  when 
this  normal  collapse  is  not  seen  it  is  generally  due  to  a  loss  of 
elasticity  as  occurs  in  emphysema,  to  inflammatory  diseases 
binding  the  lung  to  the  chest  wall,  or  to  the  alveoli  being  filled 
with  solid  or  fluid  substances  or  pent-up  air.  Most  complete 
distention  is  seen  when  death  is  due  to  drowning  or  suffocation. 

The  area  of  the  heart  uncovered  will  vary  according  to  the 
degree  of  collapse  of  the  lungs  and  to  the  abnormal  size  of  the 
heart.  Normally  the  cardiac  area  exposed  is  quadrangular  in 
shape,  and  about  three  and  a  half  inches  in  its  longest  diameter. 
Examine  the  pleural  cavities  for  the  presence  of  adhesions, 
foreign  bodies,  or  fluid.  If  fluid  is  found  it  should  be  removed, 
measured,  and  its  character  noted.  It  is  to  be  remembered  that 
in  warm  weather,  or  when  putrefaction  has  commenced,  a  mod- 
erate amount  of  reddish  serum  is  found  in  the  pleural  cavities 
which  has  no  pathological  significance.  Lastl}^,  examine  the 
mediastinum  as  to  the  condition  of  the  thymus  gland  and  great 
vessels  outside  the  pericardium. 

Pericardium. — Open  the  pericardium  b}^  an  oblique  inci- 
sion along  the  anterior  wall,  and  prolong  this  incision  down- 
ward and  outward  toward  the  diaphragm  and  upward  to  its 
reflection  from  the  great  vessels.  Normally,  about  a  drachm 
of  clear  serum,  sometimes,  however,  blood-stained  from  decom- 
position, will  be  found  in  the  pericardial  sac.  The  amount  is 
best  ascertained  by  raising  the  heart.  Note  next  the  contents 
of  the  pericardium  and  whether  there  is  any  serous,  fibrous,  or 
purulent  exudation.  If  an  abnormal  amount  of  fluid  isjjresent, 
remove,  measure,  and  note  its  character.  Observe  whether 
there  are  an}"  adhesions  between  the  two  surfaces  of  the  peri- 
cardium. White  patches  are  often  seen  on  the  visceral  surface 
of  the  pericardium,  especially  over  the  ventricles.  These  have 
no  pathological  significance  and  are  due  to  slight  thickenings  of 
the  pericardium. 

The  Heart. — Having  passed  the  hand  over  the  arch  of  the 
aorta  and  noticed  whether  there  is  any  evidence  of  aneurism  or 
dilatation,  we  grasp  the  heart  firmly  by  the  apex,  raising  and 
drawing  it  forward.     We  remove  it  by  cutting  through   the 


THE   HEART.  367 

vessels  at  its  base.  Test  the  sufRciency  of  the  aortic  and  pul- 
monary valves  by  allowing  a  stream  of  water  to  flow  into  these 
vessels,  the  heart  being  held  in  a  horizontal  position  and  care 
being  taken  not  to  pull  the  valves  open. 

To  apply  the  water  test  to  the  mitral  and  tricuspid  valves, 
the  auricles  are  first  opened  so  as  to  expose  the  upper  surface  of 
these  valves,  and  bj^  allowing  a  stream  of  water  to  flow  through 
the  aortic  and  pulmonary  valves  into  the  cavities  of  the  ventri- 
cles, the  degree  of  sufficiency  of  these  valves  can  readily  be 
ascertained. 

Another  rough  test  is  what  is  known  as  the  "finger  test." 
The  mitral  valve  will  normally  allow  two  fingers,  held  flat  and 
in  contact,  to  pass  through  its  opening.  The  tricuspid  in  the 
same  way  allows,  normally,  three  fingers  to  pass ;  or  if  a  more 
accurate  test  of  the  degree  of  insufficiency  is  desired,  the  val- 
vular orifices  should  be  measured.  Normally,  the  aortic  orifice 
is  one  inch  across;  the  mitral,  one  and  eight-tenths  inches; 
pulmonary,  one  and  two-tenths  inches;  and  the  tricuspid  about 
two  inches. 

We  open  first  the  cavity  of  the  right  ventricle  by  making  an 
incision  over  its  anterior  border  close  to  the  septum.  Prolong- 
ing the  incision  downward  to  the  apex  and  upward  through  the 
pulmonary  artery,  the  cavity  of  the  ventricle  will  be  fully 
exposed.  The  left  ventricle  is  similarly  opened  by  an  incision 
through  its  anterior  wall  which  is  prolonged  upward  through 
the  aortic  valve.  The  cavities  of  the  auricle  and  ventricle,  espe- 
cially those  of  the  right  side,  will  often  contain  blood-clots. 
These  clots  are  usualUj  post-mortem  clots  formed  during  the 
last  hours  of  life  or  after  death.  It  may  sometimes  be  neces- 
sar}"  to  distinguish  these  post-mortem  clots  from  what  are 
known  as  ante-mortem  clots.  The  latter  are  usually  of  firm 
consistencj%  dry,  of  a  whitish  color,  and  closel}'  entangled  in 
the  trabeculae,  while  the  former  are  succulent,  moist,  of  a  red- 
dish-3^ellow  color,  and  are  easily  detached  from  the  walls  of  the 
heart  cavities.  Ante-mortem  clots  are  rarel}"  seen,  and  the 
medical  examiner  should  be  careful  not  to  attribute  the  cause  of 
death  to  the  post-mortem  clots  which  are  so  often  seen.  After 
the  heart  is  opened  we  can  with  more  care  and  greater  accu- 
racy examine  the  condition  of  the  valves  and  recognize  the 
extent  of  valvular  lesions. 


368  MEDICO-LEGAL   AUTOPSIES — LOOMIS. 

The  condition  of  the  endocardium  should  now  be  examined 
and  any  abnormahtj^  noted.  Often  it  will  be  seen  stained  a 
deep  red  color.  This  is  not  due  to  disease,  but  is  caused  by  the 
absorption  of  the  coloring  matter  of  the  blood  which  has  been 
set  free  by  decomposition.  The  size  of  the  heart  cavity  and 
the  thickness  of  the  heart  walls  should  be  noted,  as  also  their 
consistency  and  color.  It  should  be  remembered  that  the  heart 
walls  may  appear  unusually  flabby  as  the  result  of  decomposi- 
tion, or  apparently  thickened  when  death  occurs  in  extreme 
systole.  The  interior  of  the  heart  can  be  further  examined  by 
passing  the  enterotome  into  each  auricle,  carrying  the  incision 
through  the  mitral  and  tricuspid  valves  to  join  at  the  apex  with 
the  previous  incision,  which  has  been  prolonged  through  the 
ventricles  to  the  apex.  Thus  tlie  auriculo- ventricular  valves 
are  completely  exposed. 

Having  removed  the  blood  from  the  heart  it  is  next 
weighed.  The  average  normal  weight  of  the  human  heart  is 
about  twelve  ounces  in  the  male,  and  a  little  less  in  the  female : 
its  size  roughly  corresponding  to  the  closed  hand  of  the  individ- 
ual. Normally,  the  thickness  of  the  walls  of  the  left  ventricle 
about  its  middle  is  five-eighths  to  two-thirds  of  an  inch,  and  of 
the  right  ventricle  one-eighth  to  one-quarter  of  an  inch. 

Note  the  condition  of  the  aorta  above  the  heart,  whether  it 
is  dilated,  atheromatous,  or  shows  calcareous  deposits.  Exam- 
ine the  coronary  arteries  by  opening  them  with  a  blunt-pointed 
scissors.  Disease  of  these  vessels  with  thrombosis  is  one  of 
the  causes  of  sudden  death  which  is  often  overlooked. 

The  Lungs. — The  lungs  are  removed  by  lifting  them  from 
the  pleural  cavity  and  cutting  through  the  vessels  and  bronchi 
at  their  base.  If  a  lung  is  very  adherent  it  is  sometimes  better 
to  remove  the  organ  with  the  costal  pleura  attached  so  as  not 
to  tear  the  lung  substance.  Examine  the  external  surface  of 
the  lung  as  to  its  shape,  color,  and  consistency.  Next  open  the 
large  bronchi  with  a  blunt-pointed  scissors,  and  prolong  the 
incision  into  the  pulmonarj' substance  along  the  minute  bronchi. 
Observe  the  contents  of  the  bronchial  tubes,  the  appearance  of 
the  mucous  membrane,  and  their  relative  thickness.  Remember 
that  it  is  very  difficult  to  tell  the  condition  in  which  the  mucous 
membrane  was  during  life  on  account  of  the  early  post-mortem 
changes  which  affect  it,  and  also  because  the  contents  of  the 


THE   LUNGS.  369 

stomach  may  have  been  forced  after  death  up  the  oesophagus 
and  down  the  bronchi,  giving  the  tubes  a  peculiar  reddish  and 
gangrenous  appearance. 

Having  examined  the  bronchi,  the  hmg  is  turned  over  and  its 
base  grasped  firmlj-  in  the  left  hand.  An  incision  is  made  from 
apex  to  base,  which  will  expose  at  a  single  cut  the  greatest  extent 
of  pulmonary  surface.  Note  the  color  of  the  lung  substance, 
and  whether  the  alveoli  contain  blood,  serum,  or  inflammatory 
products.  Blood  and  serum  can  easily  be  forced  from  the  lungs 
by  pressure  between  the  fingers,  while  inflammatory  exudations 
cannot.    Examine  carefully  for  the  presence  of  miliary  tubercles. 

If  a  question  should  arise  whether  a  portion  of  a  lung  is 
consolidated,  this  part  can  be  removed,  placed  in  water,  and  if 
the  air  cells  are  consolidated  the  portion  will  sink;  if  there  is 
only  congestion  it  will  float.  B3'  squeezing  the  lung  between 
the  fingers  an  inflammation  of  the  smaller  bronchi  (bronchitis) 
can  be  recognized  by  the  purulent  fluid  which  will  exude  at 
different  points.  It  should  be  remembered  that  in  normal  con- 
dition the  lower  lobes  and  posterior  aspect  of  the  lungs  will 
apparently  be  very  much  congested  as  a  result  of  gravity. 

Neck,  Larynx,  and  CEsophagus. — Throw  the  head  well 
backward,  and  place  a  block  beneath  the  neck.  Make  an  inci- 
sion from  the  chin  to  the  upper  part  of  the  sternum.  Dissect  the 
soft  parts  away  on  each  side  from  the  larj'nx  and  thyroid  body, 
then  cut  along  the  ijiternal  surface  of  the  lower  jaw  from  the 
symphisis  to  its  angle.  Through  this  incision  introduce  the 
fingers  into  the  mouth,  and  grasp  and  draw  down  the  tongue. 
By  dividing  the  posterior  wall  of  the  pharj-nx  and  pulling 
downward  these  parts,  the  trachea  and  oesophagus  can  readily 
be  removed  together,  a  ligature  having  been  first  placed  around 
the  lower  portion  of  the  oesophagus.  Open  now  the  phaiynx  and 
oesophagus  along  their  posterior  border.  Examine  the  mucous 
membrane  carefully  for  the  evidences  of  inflammation,  caustic 
poison,  tumors,  foreign  bodies,  or  strictures.  With  an  entero- 
tome  open  the  larynx  and  trachea  along  their  posterior  wall. 
Observe  if  there  is  anj^  evidence  of  oedema  of  the  glottis,  and 
note  the  condition  of  the  mucous  membrane.  Remember  that 
redness  of  the  larynx  is  verj"  commonly  the  result  of  post- 
mortem changes  and  is  also  seen  in  bodies  which  have  been 
kept  cold.  Dissect  off  and  examine  the  th5'roid  gland. 
24 


370  MEDICO-LEGAL   AUTOPSIES — LOOMIS. 


Abdomen. 

Having  completed  the  examination  of  the  organs  of  the 
thorax,  we  next  proceed  to  examine  those  contained  in  the  ab- 
dominal cavity.  We  first  raise  and  dissect  off  the  omentum, 
noting  if  it  is  abnormally  adherent. 

The  first  organs  to  be  removed  are : 

The  Kidneys. — Drawing  the  intestines  aside  we  cut 
through  the  peritoneum  over  the  kidneys,  and  introducing  our 
left  hand  we  grasp  the  organs  with  their  suprarenal  capsules 
attached.  Raising  first  one  kidney  and  then  the  other,  we 
easily  divide  the  vessels  and  the  ureters  as  close  to  the  bladder 
as  possible.  The  kidneys  are  often  found  imbedded  in  a  mass 
of  fat  which  must  first  be  removed.  Their  surface  is  some- 
times of  a  greenish  color  owing  to  the  beginning  of  putrefac- 
tion. We  note  the  size  of  the  organ,  its  color  and  weight.  A 
normal  kidney  weighs  from  four  and  one-half  to  five  ounces. 
Grasping  the  kidney  firmly  in  the  left  hand,  we  make  an  inci- 
sion in  its  capsule  along  its  convex  border,  and  with  a  forceps 
strip  off  the  capsule  and  note  its  degree  of  adherence  and  the 
condition  of  the  surface  of  the  organ;  whether  it  is  smooth  or 
granular.  Prolonging  our  incision  already  made  through  the 
cortex  of  the  organ,  inward  toward  the  pelvis,  we  divide  the 
organ  into  two  halves  and  now  closely  examine  the  internal 
structure.  The  average  thickness  of  the  cortex,  which  should  be 
about  one-third  of  an  inch,  is  noted ;  as  also  its  degree  of  con- 
gestion, and  whether  the  normal  light  (tubes)  and  reddish 
(vessels  and  tufts)  lines  are  seen  running  through  it.  If  these 
alternate  light  and  dark  markings  are  lost  and  the  organ  has 
not  undergone  decomposition,  the  presence  of  some  of  the  forms 
of  Bright's  disease  may  be  suspected.  If  the  cut  surface  of  the 
organ  presents  a  waxy  appearance,  the  amjioid  test  should  be 
applied  by  first  washing  the  cut  surface  of  the  organ  and  drop- 
ping upon  it  a  few  drops  of  Lugol's  solution  of  iodine,  when 
the  amyloid  areas  will  appear  as  dark  mahogany  spots  on  a 
5'ellow  background. 

The  pelvis  of  the  kidneys  should  be  examined  for  calculi  and 
the  evidence  of  inflammatory  lesions.  The  suprarenal  capsules 
readily  decompose,  but  if  the  autopsj'  is  not   made   too  late 


THE   INTESTINES.  371 

liypertrophy,  tuberculosis,  tumors,  and  degeneration   in   them 
may  be  recognized. 

The  Spleen. — This  organ  will  be  found  in  an  oblique  posi- 
tion at  the  left  side  of  the  stomach.  Grasping  it  firmly  in  the 
left  hand  and  drawing  it  forward,  it  can  easily  be  detached. 
Normally  in  the  adult  it  is  about  five  inches  in  length  by 
three  inches  in  breadth  by  one  inch  in  thickness,  and  weighs 
about  seven  ounces.  The  size,  color,  and  consistency  of  the 
organ  should  be  noted,  as  well  as  abnormal  thickenings  of  its 
capsule  and  the  presence  of  any  tubercles  or  tumors  in  its  sub- 
stance. The  spleen  softens  very  earl}-  as  the  result  of  decom- 
position, and  this  decomposition  should  not  be  mistaken  for  a 
pathological  condition. 

The  Intestines. — In  cases  of  suspected  poisoning  the 
greatest  care  should  be  taken  in  the  removal  of  the  intestines 
and  the  stomach.  Double  ligatures  should  be  placed  in  the  fol- 
lowing situations  so  as  to  preserve  the  contents  of  the  organs 
intact:  (1)  at  the  end  of  the  duodenum;  (2)  at  the  end  of  the 
ilium ;  and  (3)  at  the  lower  portion  of  the  rectum ;  and  an  in- 
cision should  be  made  with  a  pair  of  scissors  between  these 
ligatures.  The  jejunum  and  ilium  should  first  be  removed  to- 
gether by  seizing  the  gut  with  the  left  hand,  keeping  it  on  the 
stretch,  and  cutting  with  a  pair  of  scissors  through  the  mesen- 
tery close  to  its  intestinal  attachment.  The  csecum,  colon,  and 
rectum  should  then  be  removed  in  a  similar  manner. 

The  intestines  being  placed  in  large  absolutely  clean  dishes, 
which  have  previously  been  rinsed  with  distilled  water,  are 
opened ;  great  care  being  taken  that  none  of  the  intestinal  con- 
tents are  lost.  The  small  intestines  should  be  opened  in  one 
dish  and  the  large  intestine  in  another.  A  portion  of  the  in- 
testines where  morbid  appearances  are  most  likeh'  to  be  seen  in 
cases  of  poisoning  are  the  duodenum,  the  lower  part  of  the 
ilium,  and  the  rectum.  The  comparative  intensity  of  the  ap- 
pearances of  irritation  should  be  especially  noted.  For  exam- 
ple, if  the  stomach  appears  normal  and  the  intestines  are  found 
inflamed  the  possibilitj'  of  poison  from  an  irritant  may  be 
denied. 

The  intestines  are  opened  along  their  detached  border  by 
the  enterotome.  Care  should  be  taken  to  distinguish  the  post- 
mortem discolorations  which  are  usually  seen  along  the  intes- 


372  MEDICO-LEGAL   AUTOPSIES— LOOMIS. 

tines  from  those  produced  by  disease.  The  former  are  most 
marked  in  the  dependent  portions.  They  are  apt  to  occur  in 
patches  which  can  be  readily  recognized  by  stretching  the  wall 
of  the  gut.  The  darkish  brown  or  purple  discolorations  which 
are  sometimes  seen  as  the  result  of  decomposition  are  due  to  the 
imbibition  from  the  vessels  of  decomposed  haemoglobin.  Much 
care  and  experience  are  necessary  to  tell  the  amount  of  con- 
gestion which  is  within  normal  limits  and  to  recognize  changes 
of  color  produced  by  decomposition. 

The  pathological  lesions  ordinarily  looked  for  in  the  exam- 
ination of  the  intestines  are  ulcers,  perforation,  hemorrhages, 
strictures,  tumors,  and  the  evidences  of  various  inflammations. 
To  obtain  an  accurate  idea  of  the  various  portions  of  the  mucous 
membrane  of  the  intestines,  it  is  sometimes  .necessar}'' to  remove 
their  contents.  When  very  adherent  this  should  be  done  by 
allowing  as  small  a  portion  of  distilled  water  as  possible  to  flow 
over  their  surface.  If  anj'^  abnormalities  are  noticed  along  the 
intestinal  tract,  an  accurate  description  should  be  given  of  their 
situation  and  extent ;  as  also  the  amount  of  congestion  seen  in 
different  portions  of  the  intestinal  tract. 

If  possible  the  different  portions  of  the  intestines,  as  well  as 
the  stomach,  should  be  examined  immediately  after  being  ex- 
posed to  view,  as  under  the  influence  of  the  air  those  parts 
which  are  pale  may  become  red,  and  slight  redness  may  be- 
come very  pronounced.  In  this  way  only  can  we  estimate  the 
degree  of  vascularity'  of  the  various  parts  after  death.  How- 
ever, in  cases  of  suspected  poisoning,  when  it  is  impossible  for 
the  chemist  to  he  present  at  the  autopsy,  the  medical  exam- 
iner should  not  open  the  stomach  and  intestines,  but  place 
them  in  sealed  jars.  As  soon  as  possible  afterward,  the  chemist 
being  present,  they  should  then  be  examined  in  the  manner  in- 
dicated. What  may  be  lost  by  waiting,  in  changes  of  color 
which  have  taken  place,  will  be  more  than  counterbalanced  by 
the  data  which  the  chemist  will  obtain  from  observing  the  con- 
tents and  mucous  membrane  of  the  stomach  and  intestines 
when  they  are  first  exposed.  The  characteristic  odors  of  cer- 
tain poisons  are  so  evanescent  that  they  quickly  disappear  after 
opening  of  the  stomach  and  intestines. 

After  a  thorough  examination  of  the  intestines,  the}"  are 
to  be  put  with  their  contents  into  wide-mouthed  vessels,  each 


THE   STOMACH.  373 

part  by  itself,  and  the  basins  in  which  they  were  opened 
washed  with  distilled  water  and  the  washings  put  into  the 
same  bottle.  As  soon  as  the  intestines  are  transferred  to  the 
jars  they  should  be  sealed. 

The  Stomach. — The  stomach  and  duodenum  are  removed 
together.  They  are  opened  by  passing  the  enterotome  into  the 
duodenum  and  dividing  it  along  its  convex  border,  the  incision 
being  continued  along  the  greater  curvature  of  the  stomach  as 
far  as  the  oesophageal  opening.  They  should  be  opened  in  a 
large  glass  dish  which  has  been  carefully  washed  with  distilled 
water.  The  chemist  and  medical  examiner  will  carefully  note 
the  quantity,  odor,  color,  and  reaction  of  the  stomach  contents ; 
also  whether  luminous  or  not  in  the  dark;  the  presence  or 
absence  of  crystalline  matter,  foreign  substances,  undigested 
food  or  alcohol. 

Portions  of  the  contents  should  be  placed  in  a  small  glass 
bottle  and  sealed,  so  that  at  a  future  time  they  may  be  examined 
microscopically.  Only  in  this  way  can  an  absolute  knowledge 
of  the  character  of  the  stomach  contents  be  obtained.  In  cer- 
tain medico-legal  cases  the  ability  to  decide  the  character  of  the 
stomach  contents  is  of  the  utmost  importance.  The  mucous 
membranes  of  the  stomach  and  duodenum  must  be  next  care- 
fully examined  for  evidences  of  hemorrhages,  erosions,  tumors, 
and  of  acute  or  chronic  inflammations.  The  appearance  of  the 
rugae  and  their  interspaces,  principally  in  the  region  of  the 
greater  curvature,  should  be  noted ;  because  here  traces  of  poison 
and  its  effects  are  most  frequently  seen.  If  the  stomach  is  in- 
flamed, the  seat  of  the  inflammation  should  be  exactly  specified, 
as  also  that  of  any  unusual  coloration. 

The  condition  of  the  blood-vessels  are  also  noted.  Vascu- 
laritj-  or  redness  of  the  stomach  after  death  should  not  be  con- 
founded with  the  effects  of  poison  or  the  marks  of  disease.  It 
may  occur  in  every  variet}"  of  degree  or  character  and  still  be 
within  normal  limits.  Vascularities  which  we  might  call  nor- 
mal are  seen  in  the  posterior  part  of  the  greater  end  and  in  the 
lesser  curvature,  and  may  cover  spaces  of  various  extent. 
Rigot  and-  Trosseau  have  proven  b}'  experiment  that  various 
kinds  of  pseudo-morbid  redness  may  be  formed  which  cannot 
be  distinguished  from  the  varieties  caused  by  inflammation; 
that  these  appearances  are  produced  after  death  and  often  not 


374  MEDICO-LEGAL   AUTOPSIES— LOOMIS. 

until  five  or  eit^-lit  hours  afterward,  and  that  tliey  may  be  made 
to  shift  their  place  and  appear  where  the  organ  was  previously 
healthy,  merely  by  altering  the  position  of  the  stomach.  Ulcers, 
or  perforations  of  the  stomach  as  the  results  of  disease,  as  also 
the  digestion  of  the  stomach  after  death,  have  been  mistaken 
for  the  effects  of  irritant  poisons. 

When  perforation  of  the  stomach  is  the  result  of  caustic 
poisons,  the  edges  of  the  opening  are  very  irregular,  and  are  of 
the  same  thickness  as  the  rest  of  the  organ.  The  parts  not 
perforated  are  more  or  less  inflamed,  and  traces  of  the  action  of 
the  caustic  are  found  in  the  mouth,  pharynx,  and  oesophagus. 
This  is  the  opposite  condition  to  that  seen  in  spontaneous  per- 
foration. 

In  considering  perforation  of  the  stomach  the  following 
points  given  by  Taylor  are  well  to  remember : 

(1)  A  person  may  have  died  from  perforation  of  the  stomach 
and  not  from  poisoning. 

(2)  A  person  laboring  under  disease  may  be  the  subject  of 
poison. 

(3)  A  person  laboring  under  disease  may  have  received  blow^s 
or  injuries  on  the  abdomen,  and  it  will  be  necessary  to  state 
whether  the  perforation  did  or  did  not  result  from  the  violence. 

(■4)  The  perforation  of  the  stomach  from  post-mortem 
changes  may  be  mistaken  for  perforations  from  poison. 

Corrosives,  if  they  do  not  produce  perforation  of  stomach, 
will  generally  cause  intense  inflammation  accompanied  by  soft- 
ening of  the  inner  coat,  sometimes  ending  in  gangrene.  The 
inflammation  varies  as  to  its  extent  and  intensity,  sometimes 
affecting  principally  the  mouth  and  oesophagus,  but  generallj' 
the  changes  are  more  pronounced  in  the  stomach  and  duodenum, 
while  in  rare  cases  the  inflammatory  process  may  extend 
through  the  whole  alimentary  canal.  The  mucous  membranes 
are  sometimes  bright  red  with  longitudinal  or  transverse  patches 
of  a  blackish  color,  formed  by  extravasated  blood  between  the 
coats.  Carbolic  acid  often  produces  in  the  stomach  and  oesoph- 
agus white  patches — when  these  patches  are  carefully  exam- 
ined, an  ulcerated  surface  beneath  them  is  generalh*  seen. 

Narcotic  Poisons. — It  is  a  common  but  mistaken  idea  that 
these  poisons  produce  some  mark  or  characteristic  effect  upon 
the  stomach  walls ;  that  they  induce  a  rapid  tendency  to  putre- 


LIVER — PANCREAS.  375 

faction ;  that  the  blood  is  in  a  fluid  state ;  that  hemorrhages  are 
seen  in  various  parts;  that  the  stomach  and  intestines  sliow 
sloughing  without  any  inflammation.  Some  of  these  conditions 
may  and  probably  do  occur,  but  they  are  far  from  being  in- 
variable in  their  appearance.  Experiments  made  by  Orfila  on 
animals  with  narcotic  poisons  prove  the  above  statement.  In 
conclusion,  I  would  emphasize  the  fact  that  the  narcotic  poisons 
produce  no  characteristic  changes  in  the  stomach  that  can 
he  detected. 

The  liiver. — The  liver  should  be  removed  from  the  body 
and  no  attempt  made  to  examine  the  organ  in  situ.  After 
raising  flrst  one  lobe  and  then  the  other,  the  diaphragm  should 
be  cut  on  either  side  and  the  suspensory  and  lateral  ligaments 
divided,  then  the  organ  can  easily  be  removed.  The  weight  of 
the  organ  is  ascertained,  as  also  the  measurements  of  its  size 
recorded.  The  normal  weight  is  from  fift}'  to  sixty  ounces. 
The  organ  is  normall}?'  about  twelve  inches  in  length  by  seven 
inches  in  depth  by  three  and  one-half  inches  in  thickness. 

The  gall  bladder  is  first  examined  to  determine  the  character 
and  amount  of  the  bile  and  the  presence  or  absence  of  gall 
stones,  inflammatory  lesions,  and  tumors. 

At  autopsies  the  surface  of  the  liver,  especiall}"  along  the 
free  border,  is  generally  seen  to  be  of  a  greenish  or  dark-brown 
color.  This  discoloration  is  due  to  the  action  of  the  gases  de- 
veloped by  decomposition  on  the  coloring  matter  of  the  blood, 
and  has  no  pathological  significance.  The  character  of  the  sur- 
face of  the  liver  is  now  noted,  whether  smooth  or  rough.  The 
organ  is  opened  by  deep  incisions  in  various  directions,  and  the 
color,  consistency^  and  blood  supply  of  the  liver  tissue  care-' 
full}^  recorded.  The  presence  of  new  connective  tissue,  amy- 
loid degeneration,  abscesses,  or  tumors  should  not  be  overlooked. 
It  should  be  remembered  that,  of  all  the  poisons,  phosphorus 
alone  leaves  characteristic  appearances  in  the  liver. 

The  Pancreas. — The  pancreas  is  now  easily  removed,  and 
its  size  and  weight  recorded.  Normally  it  should  weigh  three 
ounces  and  measure  eight  inches  in  length  by  one  and  one-half 
inches  in  breadth  by  one  inch  in  thickness.  The  organ  should 
be  opened  by  a  longitudinal  cut  and  examined  for  evidences  of 
acute  or  chronic  inflammation,  fat-necrosis,  tumors,  calculi,  and 
amyloid  degeneration. 


376  MEDICO-LEGAL    AUTOPSIES— LOOMIS. 

Geni to-Urinary  Organs. — It  is  very  important  in  medico- 
legal cases  that  all  the  urine  should  be  preserved  and  obtained 
uncontamiiiated ;  therefore  before  the  bladder  is  opened  a  cathe- 
ter should  be  introduced  and  the  urine  dravrn  off  into  a  clean 
bottle  which  has  previously  been  rinsed  with  distilled  water. 
If  more  convenient  the  bladder  itself  can  be  punctured  at  its 
upper  portion,  a  pipette  introduced,  and  the  urine  drawn  off  in 
this  manner. 

The  genito-urinary  organs  are  removed  together.  This  is 
done  in  the  following  manner.  The  body  of  the  penis  is 
pushed  backward  within  the  skin  and  cut  off  just  behind  the 
glans  penis;  the  remaining  portion  of  the  rectum  is  raised. 
This  with  the  prostate  gland,  bladder,  and  penis  attached  is 
removed  by  carrying  the  knife  around  the  pelvis  close  to  the 
bone  and  separating  the  pubic  attachments.  The  organs  are 
then  laid  on  a  clean  board  and  the  urethra  is  opened  on  a 
grooved  director  passed  into  the  bladder,  and  the  incision  pro- 
longed so  that  the  internal  surface  of  the  bladder  itself  will  be 
completely  exposed.  Examine  the  urethra  for  strictures,  in- 
flammator}'  lesions,  and  ulcers.  Examine  the  bladder  for  con- 
gestion, hemorrhages,  inflammation,  and  ulcers  of  its  mucous 
surface,  and  note  the  thickness  of  its  walls.  Open  the  rectum 
and  examine  for  ulcers,  strictures,  tumors,  and  the  evidence  of 
hemorrhage.  The  prostate  gland  is  opened  by  a  number  of 
incisions  into  its  substance.  Examine  for  hypertrophies, 
tumors,  and  inflammatory  lesions.  Force  the  testicles  tlirough 
the  inguinal  canal,  and  cut  them  off.  Weigh,  open,  and  exam- 
ine them  for  evidence  of  inflammation,  tuberculosis,  and  tumors. 

Female  Organs. — Before  removing  these  organs,  any 
abnormalities  such  as  adhesions,  malpositions,  and  tumors 
should  be  noted.  Dissect  the  organs  away  from  the  pelvic 
bones  by  carrying  the  point  of  the  knife  around  the  pelvis  close 
to  the  bone.  Cut  through  the  vagina  at  its  lower  third,  and 
the  rectum  just  above  the  anus.  The  organs  can  now  readily 
be  removed.  Examine  the  vulva  for  ulcers,  hypertrophies,  and 
tumors.  Open  and  examine  the  bladder.  Open  the  vagina 
along  its  anterior  border  and  carefully  examine  its  mucous  sur- 
face for  evidences  of  inflammation. 

The  Uterus. — Before  opening  the  uterus,  its  size  and  shape 
should  be  recorded.     The  average  normal  weight  of  the  organ 


THE    SPINAL    CORD.  377 

is  about  one  and  one-quarter  ounces ;  ii^  length  three  inches, 
breadth  two  inches,  and  thickness  one  inch.  Open  the  organ 
along  its  anterior  surface  bj^  a  blunt-pointed  scissors  passed 
through  the  cervix,  and  the  incision  carried  as  far  as  the 
fundus.  Note  the  thickness  of  its  walls  and  anj^  abnormalities 
of  its  mucous  membrane.  During  menstruation,  the  mucous 
membrane  of  the  body  is  thickened,  softened,  and  covered  with 
blood  and  detritus.  Retention  cysts  are  found  in  the  mucous 
membrane  of  the  cervix  and  are  not  generally  of  pathological 
significance. 

Remove,  measure,  and  weigh  the  ovaries.  Their  normal 
weight  is  about  one  drachm  each ;  their  size,  one  and  one-half, 
by  three-quarters,  by  one-half  inch.  Open  the  organs  b}^  a 
single  incision  and  examine  for  the  evidences  of  acute  and 
chronic  inflammations,  tumors,  and  cysts.  The  corpora  lutea 
in  various  stages  can  be  easil}'  recognized  in  the  substance  of 
the  organ.  Open  the  Fallopian  tubes  and  examine  their  con- 
tents and  the  condition  of  their  membranes  (see  Disputed 
Pregnancy  and  Delivery,  Vol.  II.). 

The  Spinal  Cord. 

To  remove  the  cord,  the  body  should  be  placed  on  its  face 
with  a  block  beneath  the  thorax.  An  incision  is  made  through 
the  skin  and  muscles  along  the  entire  length  of  the  vertebral 
column  and  the  soft  parts  dissected  away  so  as  to  expose  the 
transverse  process  of  the  vertebrae.  The  lamina  are  divided 
with  a  saw  through  the  articulate  process  (a  double-bladed  saw 
specially  adapted  for  this  work  can  be  obtained).  After  the 
lamina  have  been  complete!}'  severed,  these  together  with  the 
spinoiis  process  can  now  be  readily  torn  away  with  a  stout  hook 
and  the  cord  exposed.  A  long  chisel  with  a  wooden  mallet  will 
often  greatly  facilitate  this  work.  Great  care  should  be  exer- 
cised not  to  injure  the  cord.  The  roots  of  the  spinal  nerves  are 
now  severed,  and  the  cord  removed  within  its  membrane.  It 
should  be  remembered  that  serous  fluid  within  the  membranes 
of  the  cord,  as  also  intense  congestion,  especiall}'  along  its  pos- 
terior aspect,  is  often  seen  as  the  result  of  post-mortem  change. 
The  cord  is  laid  on  a  clean  board  and  the  dura  mater  opened 
with  a  blunt-pointed  scissors  along  its  anterior  aspect,  and  an 
examination  made  for  the  presence  of  hemorrhage,  inflamma- 


378  MEDICO-LEGAL   AUTOPSIES — LOOMIS. 

tory  lesions,  and  tumqrs.  Softening  of  the  cord  can  generallj- 
be  detected  by  the  finger  passed  along  it.  This,  however,  is 
not  a  perfectly  accurate  test,  especially  if  the  body  has  been  dead 
some  time.  The  cord  is  now  cut  by  transverse  incisions  about 
half  an  inch  apart  throughout  its  entire  length,  and  the  cut  sur- 
face examined  for  the  evidences  of  disease  such  as  hemorrhages, 
softening,  and  inflammatory  lesions. 

After  the  cord  has  been  removed,  examine  the  vertebral  col- 
umn for  the  evidences  of  fractures  and  displacements. 

LATE   AUTOPSIES. 

Late  autopsies  are  those  performed  after  partial  or  complete 
destruction  of  the  soft  parts  of  the  body,  through  the  natural 
processes  of  decomposition,  or  the  examination  of  bones  ex- 
humed long  after  interment.  The  term  may  be  employed  also 
to  mean  the  inspection  of  an  embalmed  body,  dead  for  some 
time. 

The  object  of  late  autopsies  is  to  determine  identity,  or 
to  establish  the  guilt  or  innocence  of  suspected  persons.  An 
examination  of  the  skeleton  even  many  years  after  death  may 
give  important  information  as  to  the  manner  in  which  the 
deceased  came  to  his  end.  This  cannot  better  be  illustrated 
than  by  the  citation  of  one  or  two  cases. 

In  the  celebrated  case  of  "Eugene  Aram,"  the  bones  of  his 
victim  were  discovered  thirteen  years  after  the  crime  had  been 
committed.  A  man  who  afterward  proved  to  be  Aram's  accom- 
plice was  arrested  on  suspicion.  He  confessed  the  crime,  and 
the  opinion  formed  by  the  medical  witnesses  was  confirmed  by 
his  statements.  The  skull  presented  evidence  of  fracture  and 
indentation  of  a  temporal  bone.  Aram  argued  the  case  in  his 
own  behalf,  but  the  testimony  was  too  strong  against  him :  he 
was  convicted  and  executed. 

Taylor  records  the  case  of  a  man,  Guerin,  who  was  con- 
victed of  the  murder  of  his  brother  from  evidence  obtained 
from  an  examination  of  the  skeleton  three  j^ears  after  inter- 
ment. Here,  again,  blows  upon  the  head  were  the  cause  of 
death,  and  the  fractures  were  plainlj-  perceptible  upon  the  ex- 
humed skull. 

An  autopsy  upon  a  bod}'  before  the  soft  parts  have  been 


LATE    AUTOPSIES.  379 

entirely  destroyed,  or  upon  an  embalmed  body,  should  be  con- 
ducted in  much  the  same  manner  as  ordinary  autopsies.  In 
these  cases  the  method  of  burial  should  be  noted.  If  it  be 
a  case  of  murder,  and  the  body  has  been  hurriedly  put  into 
the  ground,  it  is  not  likely  that  the  custom  of  Christian  nations 
has  been  observed — that  of  laying  the  body  full  length,  with  the 
head  to  the  west. 

In  the  case  of  partially  destroyed  bodies,  the  remaining  soft 
parts  will  give  little  evidence  of  the  mode  of  death  unless  the 
violence  has  been  very  extensive,  and  even  then  it  may  be  im- 
possible to  determine  whether  a  wound  was  inflicted  prior  to  or 
after  death.  Recourse  must  be  had  to  the  skeleton,  and  the 
only  evidence  it  can  furnish  is  of  fractures,  unless,  as  hap- 
pened in  one  case,  a  rope  be  found  about  the  cervical  vertebrae. 

When  the  skeleton  only  is  found,  Taylor  lays  stress  upon 
the  following  points : 

(1)  Whether  the  bones  belong  to  a  human  being  or  one  of 
the  lower  animals. 

(2)  If  a  human  being,  whether  male  or  female. 

(3)  The  length  of  time  they  have  probably  remained  in  the 
ground. 

(4)  The  probable  age  of  the  individual  to  whom  they  be- 
longed. If  the  maxillary  bones  be  found,  much  information 
may  be  obtained  from  an  examination  of  the  teeth. 

(5)  The  probable  stature  of  the  individual  during  life. 

(6)  The  race  to  which  he  belonged.  The  conformation  of 
the  skull  and  thickness  of  the  bones  will  give  important  infor- 
mation on  this  point. 

(7)  It  should  be  determined  whether  solitary  bones  belong 
to  the  right  or  left  side,  and  whether  they  form  parts  of  one  or 
more  than  one  skeleton. 

(8)  Whether  they  have  been  fractured,  and  if  so,  whether  it 
occurred  during  life,  or  by  accident  at  the  time  of  the  exhuma- 
tion. If  it  occurred  during  life,  whether  it  be  recent  or  of  long 
standing. 

(0)  The  presence  or  absence  of  personal  deformities,  of 
supernumerary  fingers  or  toes,  of  curvature  of  the  spine,  of 
ankylosis  of  one  or  more  joints. 

(10)  Whether  they  have  been  calcined,  as  murderers  some- 
times try  to  make  away  with  the  bodies  of  their  victims  by 


380  MEDICO-LEGAL   AUTOPSIES— LOOMIS, 

burning.  Especially  is  this  the  case  in  infanticides  (see 
Identity,  Vol.  I.,  p.  408  et  seq.;  Time  of  Death,  Vol.  I.,  p. 
452  et  seq.). 

AUTOPSIES  or   FRAGMENTS. 

These  cases  are  usually  cases  of  murder  in  the  perpetration 
of  which  the  criminal  has  mutilated  the  body  with  a  view  to 
destroying  all  traces  of  identit5^ 

The  importance  which  attaches  to  autopsies  of  fragments 
rests  upon  the  fact  that  parts  of  a  body  may  be  found  widely 
separated,  and  that  one  portion  may  be  found  before  the  others. 
In  such  cases  it  will  be  necessary  to  determine  if  they  belong 
to  one  and  the  same  body.  The  examination  is  conducted 
chiefly  with  a  view  to  establishing  this. 

The  examiner  must  note  the  manner  in  which  the  fragment 
has  been  separated;  whether  it  is  clean  cut,  as  by  one  who 
understood  something  of  anatomy,  or,  whether  it  has  been  sep- 
arated roughly  and  by  one  ignorant  of  the  body  structure.  The 
determination  of  this  point  will  be  one  link  in  the  chain  of 
evidence  which  may  lead  to  the  detection  of  the  criminal,  or  the 
acquittal  of  one  accused.  An  anatomist  or  a  butcher  would  be 
likely  to  cut  through  at  a  joint,  and  to  do  it  neatly.  The  exact 
point  at  which  the  severance  has  taken  place  should  be  noted. 
The  place  of  finding,  the  circumstances  under  which  found,  the 
condition  and  general  appearance  of  the  fragment  should  all  be 
carefully  recorded.  The  color  of  the  skin  will  indicate  with 
some  accuracy  the  race  to  which  the  individual  belonged.  The 
probable  sex  may  be  determined  bj^  the  presence  or  absence  of 
hair,  and  the  general  conformation.  This,  however,  will  not 
apply  in  the  case  of  children.  The  probable  age  may  be  fixed 
upon  from  the  size  and  degree  of  development  of  the  fragment. 
The  cut  surface  should  be  carefully  described,  and  if  possible  a 
drawing  should  be  made  of  it. 

There  are  special  considerations  which  apply  to  certain  parts 
of  the  body. 

The  Head. — The  exact  point  of  severance  should  be  re- 
corded. The  number  of  vertebrae  which  remain  attached  to 
the  head  should  be  counted,  and  if  the  section  pass  through  a 
vertebra,  its  number  and  the  amount  of  it  missing  should  be 
stated.     The  sex  will  be  apparent  in  all  instances;  the  race  may 


MEDICO-LEGAL  REPORTS.  381 

be  determined  both  by  the  color  of  the  skin  and  by  the  shape  of 
the  head ;  the  age  may  be  approximated,  though  care  must  be 
had  in  expressing  an  opinion,  for  the  manner  of  hving  is  well 
known  to  affect  the  appearance  of  age.  Evidence  of  violence 
prior  to  death  should  be  noted,  and  the  presence  or  absence  of 
fractures  ascertained;  also  observe  the  color  of  the  hair  and 
whether  it  be  thin  or  abundant;  the  presence  or  absence  of 
beard  or  mustache,  and  if  present  the  color;  and  the  color  of 
the  eyes. 

The  Arm. — The  following  points  should  be  determined: 
the  color  of  the  skin  as  indication  of  race;  the  probable  sex 
from  its  shape  and  general  conformation;  the  probable  age 
from  its  size  and  degree  of  development ;  marks  of  any  kind, 
such  as  tattooing;  and  deformities,  such  as  signs  of  old  or 
recent  fracture,  or  dislocation;  and  supernumerary  fingers. 

The  Leg. — The  examination  of  the  leg  should  be  conducted 
in  much  the  same  manner  as  that  of  the  arm. 

The  Trunk. — An  examination  of  the  trunk  will  reveal  the 
race,  sex,  and  probable  age,  and  may  give  evidence  as  regards 
the  manner  in  which  the  deceased  came  to  his  or  her  death. 
Any  marks  or  deformities  should  be  recorded,  and  in  all  cases 
the  viscera  should  be  examined. 

MEDICO-LEGAL   REPORTS.' 

After  making  a  medico-legal  autopsy,  it  will  be  necessary 
for  the  medical  examiner  to  draw  up  a  report  of  his  findings, 
and  the  conclusions  based  thereon.  The  report  should  be  clear 
and  concise,  and  the  language  such  as  a  coroner's  jury  can 
understand.  Technical  terms  should  be  avoided,  and  when 
their  employment  is  necessary  they  should  be  explained  in  the 
margin  or  in  parentheses. 

The  report  should  be  drawn  up  in  somewhat  the  following 
manner : 

1.  When  and  under  what  circumstances  the  body  was  first 
seen;  stating  hour  of  day,  day  of  week  and  month. 

2.  When  deceased  was  last  seen  living,  or  known  to  be  alive. 

'  The  facts  upon  which  the  follow-       Stevenson's  Taylor,  vol.  i.,p.  204  et 
ing  statements  are  based  have  been      seq. 
largely  drawn  from   Taylor.      See 


382  MEDICO-LEGAL   AUTOPSIES— LOOMIS. 

3.  Any  circvimstances  that  would  lead  to  a  suspicion  of 
suicide  or  murder. 

4.  Time  after  death  at  which  the  examination  was  made,  if 
it  can  be  ascertained. 

5.  The  external  appearance  of  the  body:  whether  the  surface 
is  livid  or  pallid. 

6.  State  of  countenance. 

7.  An}'  marks  of  violence  on  the  person,  disarrangement  of 
the  dress,  blood -stains,  etc. 

8.  Presence  or  absence  of  warmth  in  the  legs,  abdomen, 
arms,  armpits,  or  mouth. 

9.  Presence  or  absence  of  rigor  mortis. 

To  give  any  value  to  this  point  it  is  necessary  for  the 
witness  to  observe  the  nature  of  the  substance  upon  which  the 
bod}^  is  lying ;  whether  the  bod}'  be  clothed  or  naked,  young  or 
old,  fat  or  emaciated.  These  conditions  materially  influence 
the  rapidity  of  cooling  and  the  onset  of  rigor  mortis. 

10.  Upon  first  opening  the  body  the  color  of  the  muscles 
should  be  noted.  Carbon  monoxide  poisoning  causes  them  to  be 
of  a  cherry-red  color. 

11.  The  condition  of  the  blood  and  its  color. 

12.  The  state  of  the  abdominal  viscera,  describing  each  one 
in  the  order  in  which  it  is  removed  (seep.  370).  If  the  stomach 
and  intestines  are  inflamed  the  seat  of  the  inflammation  should 
be  exactly  specified;  also  all  evidences  of  softening,  ulceration, 
effusion  of  blood,  coiTosion,  or  perforation.  The  presence  of 
hardened  faeces  in  the  rectum  will  bear  evidence  that  no  purging 
occurred  immediately  before  death. 

13.  The  state  of  the  heart  and  lungs.  (For  special  consider- 
ation of  the  lungs  in  cases  of  suspected  infanticide,  see  Vol.  II. ; 
and  of  persons  drowned,  see  Vol.  I.,  p.  805  et  seq.). 

14.  The  state  of  the  brain  and  spinal  cord. 

After  a  thorough  consideration  of  the  results  of  the  exam- 
ination, conclusions  must  be  drawn  from  this  examination; 
never  from  the  statements  of  others.  The  conclusions  com- 
monly relate  to  whether  death  was  due  to  natural  or  imnatural 
causes ;  if  to  unnatural  causes,  what  are  the  facts  which  lead 
the  examiner  to  this  opinion.  As  the  conclusions  are  intended 
to  form  a  summary  of  the  whole  report,  they  must  be  brief  and 
tersely  stated. 


PERSONAL    IDENTITY, 


INCLUDING 


THE  METHODS  USED  FOR  ITS  DETERMINATION  IN  THE 
DEAD  AND  LIVING. 


BY 

IRVING  C.  R03SE,  A.M.,  M.D.,  F.R.G.S.  (Eng.), 

Prof essor  of  Nervous  Diseases,  Georgetown  University;  Membredu 
Congres  International  cV Anthropologie  Criniinelle,  etc. 


PERSOI^AL  IDENTITY. 

GENERAL    CONSIDERATIONS. 

Identity  is  the  determination  of  the  individuality  of  a  per- 
son. In  jurisprudence  the  term  is  applied  to  the  recognition 
of  a  person  who  is  the  object  of  a  judicial  action.  The  estab- 
lishment of  the  individuality  of  a  person  is  known  as  absolute 
identity ;  while  the  relations  of  a  person  with  some  particular 
act  is  known  as  relative  identity. 

The  great  number  and  variety  of  facts  concerned  in  the 
investigation  of  questions  of  identity  are  of  considerable  gravity 
and  importance  in  their  juridical  bearing,  and  at  the  same  time 
they  are  among  the  most  interesting  and  most  useful  of  the 
applications  of  modern  medicine  to  the  purposes  of  the  law.' 

Among  the  varied  researches  of  legal  medicine  looking  to 
an  interpretation  of  facts,  no  other  question  ocgurs  in  which 
the  solution  depends  more  upon  morphological  and  anatomical 
knowledge,  and  none  is  more  dependent  upon  purely  objective, 
visible,  tangible  facts. 

Personal  identity  often  constitutes  the  entire  subject-matter 
of  dispute  in  a  civil  case.  Upon  it  may  depend  the  question  of 
absence  or  of  marriage,  of  kinship  or  of  filiation  involving  the 
possession  of  an  estate,  in  which  case  the  court  often  requires 
the  most  subtle  of  scientific  evidence  to  assist  in  its  decision. 
Many  anthropological  and  medical  facts,  now  appropriated  by 
criminology  and  penal  science,  are  useful  in  proving  not  only 
the  present  but  in  attesting  future  identity,  thereby  preventing 
in  great  lueasure  the  dissimulation  of  prisoners,  deserters,  false 
claimants  to  life  insurance,  fraudulent  pensioners,  and  the  like. 

Such  matters  are  of  daily  occurrence.     The  special  agents 

of  the  U.  S.  Pension  Office  detect  and  cause  the  punishment  of 

'Recent    attention    to  such   sub-       from  our  own,  this  fact  does  not  les- 
jects  by  Italian  writers  places  them      sen  tlie  vahie  of  their  medico-foren- 
iu  tlie    foremost    rank.     Altliough      sic  literature, 
their  system  of  judicature  differs 
25 


;58G  IDENTITY — ROSSE. 

many  fraudulent  claimants.  Stratagems  and  conspiracies  to 
defraud  life-insurance  companies  go  much  further  than  mere 
substitution.  Instead  of  a  "  fraudulent"  a  positive  death  may 
come  up  for  investigation,  and  in  order  to  defraud  an  insurance 
company  of  a  large  amount,  a  bod}'  may  even  be  procured  by 
homicide  to  consummate  the  deception,  as  was  done  in  the 
Goss-Udderzook  tragedy  near  Baltimore  in  1872. 

A  celebrated  case  now  before  the  Supreme  Court  of  the 
United  States  and  involving  the  question  of  personal  identity 
is  that  of  the  Mutual  Life  Insurance  Company  of  New  York, 
the  New  York  Life  Insurance  Company,  and  the  Connecticut 
Mutual  Life  Insurance  Company  of  Hartford,  Connecticut 
(Consolidated),  plaintiffs  in  error,  vs.  Sallie  E.  Hillmon. 

It  is  pre-eminently  in  criminal  trials  that  the  personal  iden- 
tity of  the  victim  often  constitutes  an  essential  connecting  link. 
Before  it  can  move,  the  law  requires,  at  the  outset,  proof  of  the 
individuality  of  both  the  author  of  a  crime  and  of  the  victim. 
I  shall,  therefore,  not  touch  upon  such  elusive  individuals  as 
Charlie  Ross  and  Jack  the  Ripper,  but  limit  my  remarks  to 
a  sj'uthetical  exposition  of  the  best-known  facts  regarding 
identification  of  the  dead  body  and  the  interpretation  of  its 
organic  remains. 

The  identity  of  a  living  person,  or  even  our  own  identity, 
is  often  a  difficult  point  to  establish.  It  may  also  require  medi- 
cal evidence,  oftentimes  of  a  most  involved  character,  to  estab- 
lish the  fact  of  death.  Hence  the  medico-legal  process  of  con- 
necting a  dead  body,  or  the  remains  or  traces  of  the  same,  with 
a  human  being  once  known  to  have  lived  and  moved  on  earth, 
is  beset  with  difficulties  that  may  give  rise  to  still  greater 
antagonisms  of  evidence.  The  question  of  personal  identity  is 
one  of  the  hardest  that  could  possibly  come  before  a  court. 
Celebrated  cases  and  judicial  errors  have  given  it  great  noto- 
riety. There  are  consequently  few  questions  in  forensic  medi- 
cine that  require  more  attention  and  sagacity,  and  none  upon 
which  the  medical  legist  should  pronounce  with  more  reserve 
and  circumspection.  Medical  men  are  absolutely  the  only 
persons  qualified  to  assist  in  resolving  the  really  delicate  ques- 
tion of  personal  identity;  yet  the  phj^sician  and  the  lawyer 
pursue  the  same  line  of  logic  and  of  inquiry.  As  the  former 
must  have  a  subject  to  dissect  or  to  operate  upon,  so  must  the 


GENERAL   CONSIDERATIONS.  387 

lawyer  in  pursuing  a  criminal  investigation  first  prove  a  visible 
material  substance  known  in  legal  phraseology  as  the  corpus 
delicti,  which  he  must  connect  with  some  personality,  with 
some  human  being  once  known  to  have  lived.  In  this  impor- 
tant process  the  physician's  testimony  being  the  indispensable 
guide  of  the  court's  inference,  he  should  limit  himself  to  purely 
anatomical  and  material  knowledge.  The  medical  expert  has 
absolutely  nothing  to  do  with  guilt  or  innocence,  as  that  is  a 
question  for  the  jury.  He  should,  above  all  things,  be  abso- 
lutely free  from  prejudice,  suspicion,  or  undue  suggestion,  and 
should  remember  that  in  thus  sinking  his  personality  his  sole 
function  as  a  skilled  witness  in  cases  of  identity  is  to  furnish 
testimony  which,  when  taken  in  connection  with  other  evidence 
in  the  case,  may  establish  such  a  corpus  delicti  Si^  would  justify 
the  inference  of  a  crime. 

A  nice  point  may  arise  as  to  dispensing  with  the  proof 
from  the  body  itself,  when  the  substantial  general  fact  of  a 
homicide  is  proved  aliunde,  as  in  the  case  of  a  criminal  caus- 
ing the  disappearance  of  his  victim's  body  by  means  of  its 
decomposition  in  lime  or  other  chemical  menstrua,  or  by  sub- 
inerging  it  in  an  unfathomable  spot  in  the  sea.  Under  cir- 
cumstances such  as  the  following :  a  person  is  seen  to  enter  a 
building  and  is  not  seen  to  leave  it,  although  all  means  of 
egress  therefrom  are  watched ;  another  person  is  seen  to  ignite 
the  building,  which  thereupon  burns  down,  and  the  charred 
remains  of  a  human  body  are  found  in  the  ruins ;  the  proof  of 
identity  from  the  body  itself  might  be  dispensed  with  in  view 
of  the  substantial  general  fact  of  a  homicide  having  been  com- 
mitted. In  a  delicate  case  where  the  man  of  art  hesitates  and 
finds  no  corpus  delicti,  the  investigation  of  imprints  and  stains 
may  give  a  clew  of  great  value  to  the  expert.  Yet  it  is  only 
upon  absolute  evidence,  and  in  the  strongest  possible  case,  that 
the  fundamental  principle  of  the  corpus  delicti  is  disregarded. 

In  the  case  of  Ruloff,  the  child's  body  was  not  produced 
and  no  trace  of  it  could  be  alleged  to  have  been  found ;  never- 
theless the  prisoner  was  found  guiltj^  of  murder.  This  case 
was  speedily  overruled  (18  N.  Y.,  179),  on  the  ground  that  a 
dangerous  precedent  had  been  pronounced. 

So  indispensable  is  the  showing  of  the  corpus  delicti  in 
cases  of  recognition  that  lawyers  have  come  to  regard  even  the 


388  IDENTITY — ROSSE. 

judicial  confession  of  an  accused  as  often  the  flimsiest  and 
most  unsatisfactoiy  kind  of  evidence.  Numerous  cases  of 
demonstrated  fallibility  of  confessions  are  cited  in  the  books, 
where  the  statement  was  utterly  lacking  in  anything  except 
motive  or  hallucination.  In  the  Proceedings  of  the  New  York 
Medico-Legal  Society,  December  6th,  1876,  Mr.  James  Appleton 
Morgan  mentions  the  case  of  a  German  servant-girl  who  as- 
sured her  mistress,  whose  little  boy,  a  child  of  seven,  had  just 
died  and  been  buried,  that  she  (the  servant)  had  poisoned  the 
boy.  The  servant  swore  to  her  crime  and  was  taken  into  cus- 
tody, and  it  was  only  when  no  poison  was  discovered  upon 
exhuming  the  child's  body  and  examining  its  stomach  that 
against  her  own  protest  she  was  acquitted  of  the  possibility  of 
the  crime.  Another  case  of  the  kind  that  has  had  medico-legal 
notoriety  was  tried  a  few  years  ago  before  a  court  in  Brittany. 
The  accused  declared  that  he  had  killed  his  servant  and  thrown 
the  body  in  a  pond.  His  guilt  seemed  certain,  when  the  alleged 
victim  put  in  an  appearance,  thus  reducing  the  evidence  to  the 
strange  hallucination  that  had  prompted  the  confession. 

But  the  most  wonderful  of  these  is  the  celebrated  case  of 
Boorn,  in  which  medico-legal  evidence  took  no  part.  In  view 
of  the  seeming  hopelessness  of  his  case,  the  accused  confessed 
to  murder  in  expectation  of  mercy  frora  the  court,  but  was 
finally  acquitted  on  the  alleged  victim  walking  into  court  and 
confronting  the  man  who  had  sworn  to  having  killed  him. 

Although  wisdom  and  experience  point  to  the  necessity  of 
showing  something  corporal  and  material  in  cases  involving 
questions  of  life  and  death,  yet  very  small  traces  or  minute 
remains  of  a  human  body  may,  in  certain  circumstances,  con- 
stitute a  corpus  delicti  that  may  lead  to  trial  if  not  to  convic- 
tion. In  1868  the  Lambert  case,  for  murder  on  the  high  seas, 
was  tried  before  Judge  Benedict  in  the  United  States  Court, 
the  only  corpus  delicti  alleged  being  a  large  pool  of  blood  and 
brains  found  on  the  forecastle  of  a  ship  at  sea,  out  of  sight  of 
land  or  other  vessel.  Circumstances,  acts,  and  words  pointed 
strongly  to  the  murder  of  one  of  the  crew,  who  was  believed  to 
have  been  brained  with  an  axe  and  thrown  overboard.  Not- 
withstanding the  fact  that  animosity  was  known  to  exist  be- 
tween the  accused  and  the  missing  man,  it  further  appeared 
that  the  accused,  in  a  state  of  great  excitement,  had  followed 


IDENTITY    OF   BURNT    REMAINS.  389 

the  missing  man  forward  and  returned  alone  with  a  hatchet  in 
his  hand,  yet  the  jury  in  this  instance  were  not  satisfied  as  to 
the  establishment  of  a  corpus  delicti  beyond  a  reasonable  doubt 
and  accordingly  failed  to  convict. 

Two  classical  cases,  that  of  Gardelle  and  of  Dr.  Webster, 
mentioned  in  many  of  the  books,  stand  forth  as  instances  of 
conviction  where  fragments  of  the  human  body  were  recognized 
after  attempts  to  destroy"  them  by  intense  heat.  The  conviction 
of  Dr.  Webster  rested  almost  entirely  upon  medico-legal  evi- 
dence; but  it  is  probable  that  upon  the  same  circumstantial 
evidence  the  increased  industry  of  counsel  would  have  so  rung 
the  changes  in  regard  to  its  uncertain  and  unsafe  nature,  and 
would  have  so  used  the  knowledge  gained  from  advanced  dis- 
coveries in  the  regions  of  the  probabilities  of  science,  as  to 
have  secured  the  acquittal  of  the  prisoner  had  the  trial  taken 
place  at  the  present  time. 

A  similar  affair  of  great  medico-legal  interest  is  the  Goss- 
Udderzook  tragedy,  already  referred  to,  an  account  of  which  is 
given  by  Drs.  Lewis  and  Bombaugh  among  the  "  Remarkable 
Stratagems  and  Conspiracies  for  Defrauding  Life  Insurance 
Companies,"  New  York  and  London,  1878. 

IDENTITY  OF  BURNT  REMAINS. 

The  medical  jurist  will  no  doubt  find  cremation  a  formida- 
ble barrier  in  elucidating  the  question  of  identit}^,  although  the 
entire  destruction  of  a  dead  body  is  a  matter  of  extreme  diffi- 
culty. 

In  the  case  of  calcination  chemical  analysis  of  the  ash 
"would  detect  the  phosphate  of  lime,  but  this  would  throw  no 
light  upon  the  subject,  since  the  ash  of  human  bones  and  that 
of  the  lower  animals  is  identical.  If  the  burnt  bone  is  entire, 
the  state  of  the  epiphyses  may  enlighten  the  question  of  the 
determination  of  age.  The  following  two  cases,  in  which  frag- 
ments or  portions  of  bone  had  been  submitted  to  the  action  of 
fire,  show  how  medical  training  and  some  knowledge  of  com- 
parative anatomy  may  contribute  to  the  establishment  of  guilt 
or  ma}'  attest  innocence. 

In  the  case  of  The  Queen  vs.  John  Henry  Wilson,  for 
murder,  the  accused  burnt  his  step-father  in  a  lime-kiln  foi 


;J90  IDENTITY — ROSSE. 

over  a  week,  and  on  strewing  ashes  from  the  kiln  fine  frag- 
ments of  bono  picked  up  wore  afterward  identified  as  human. 
At  the  trial  identity  rested  on  the  fact  of  finding  two  buttons 
and  a  buckle,  which  were  recognized  as  part  of  the  deceased's 
wearing  apparel  when  last  seen. 

In  the  second  case,  that  of  a  young  woman  supposed  to  be 
in  the  family  way  who  should  not  have  been,  it  was  thought 
that  she  had  been  confined  and  made  away  with  the  infant. 
Under  this  supposition  the  premises  where  she  lived  were 
searched  by  the  chief  constable,  who  found  in  the  stove  some 
bones  and  fragments  of  bones  that  had  been  burnt.  On  exami- 
nation by  a  qualified  medical  man,  the  fragments  turned  out 
to  be  not  human  bones,  but  those  of  some  other  animal,  presum- 
ably those  of  a  pig  and  of  a  chicken,  which  the  family,  who 
lived  in  a  tenement-house  without  a  back  yard,  had  put  in  the 
stove  to  get  rid  of  the  refuse. ' 

IDENTIFICATION  OF  HUMAN   BONES. 

In  deciding  whether  certain  bones  are  human  or  not,  the 
medical  jurist  should  exercise  great  caution  in  venturing  an 
opinion  as  to  the  precise  animal  of  which  he  may  believe  they 
formed  a  part.  There  is  no  great  difficulty  in  detecting  the- 
smallest  fragments  of  bone  by  means  of  the  microscope,  but  we 
cannot  say  with  safety  whether  the  fragments  belonged  to 
a  mouse,  a  man,  or  an  elephant.  A  real  difficulty  occurs  in 
recognizing  the  nature  and  origin  of  the  bony  remains  when 
only  a  small  fragment  or  a  single  bone  is  submitted  for  report. 
If  a  sufiicient  portion  of  the  skeleton  be  submitted  it  can  be 
easily  recognized  as  human,  as  in  the  imbedded  remains  of  the 
troglodyte  found  in  the  limestone  deposit  of  Luray  Cave,  Vir- 
ginia, and  only  in  the  exceptional  case  of  the  bones  of  one  of 
the  manlike  apes  could  a  difficulty  of  distinction  arise.  The 
characteristic  signs  that  distinguish  a  goriUa  skeleton,  for  in- 
stance, are  the  smaller  thumb ;  notable  length  of  tibia  and  of 
radius,  although  this  relative  length  of  extremities  has  been 
remarked  in  negroes ;  small  facial  angle,  30°  to  40°  in  the  mon- 
key, 70°  to  80°  in  man;  ver}'  inferior  cranial  capacity,  the 
maximum  in  a  gorilla  being  550  cubic  centimetres,  while  the 
'Canada  Med.  and  Surg.  Journal,  1875,  vol.  iii.,  pp.  56-60. 


IDENTIFICATION    OF    HUMAN    BONES.  391 

minimiim  in  the  human  species  is  from  970  with  a  maximum 
of  1,500  to  1,900  centimetres;  a  low  index  of  the  foramen  mag- 
num ;  convexity  of  the  squamo-parietal  suture,  and  larger  and 
more  salient  canines  and  incisors.  The  volume  of  the  endo- 
cranium  in  the  female  gorilla,  like  that  of  the  human  species, 
is  smaller  than  that  of  the  male ;  this  difference  being  almost 
80  c.c.  for  the  anthropoid  female. 

In  studying  the  osseous  system  it  should  be  remembered 
that  certain  modifying  elements,  as  artificinl  compression,  patho- 
logical deformities, .  posthumous  distortions,  and  hygrometric 
conditions,  may  affect  particularly  the  skull,  and  if  due  allow- 
ance be  not  made  for  these  the  study  may  lead  to  glaring  absurd- 
ities. Not  longer  ago  than  1725  there  was  found  in  a  quarry 
at  CEningen  the  skull  of  a  fos'feil  batrachian  compressed  into 
rude  resemblance  to  the  human  cranium,  which  was  announced 
to  the  world  as  Scheuchzer's  "Homo  diluvii  testis  et  theo- 
scopos,"  and  as  the  remains  of  one  of  the  sinful  antediluvians 
who  perished  in  the  Noachic  deluge. 

Are  the  Bones  Old  or  Recent? 

An  important  point  may  arise  in  questions  of  identification 
of  bones  as  to  the  oldness:  whether  they  are  old  or  recent. 
The  first  indication  is  furnished  by  the  presence  or  by  the 
absence  of  the  soft  parts.  The  existence  of  the  periosteum  and 
of  the  spinal  marrow  is  the  most  persistent  proof  of  a  recent 
state ;  but  these  alone  with  the  soft  parts  are  usually  destroyed 
in  two  or  three  years.  In  ordinary  circumstances  a  body  be- 
comes skeletonized  in  about  ten  years,  although  in  exceptional 
cases  the  cadaver  may  resist  decomposition  after  many  years.* 

This  summer  in  transferring  an  old  cemetery  in  George- 
town, D.  C,  the  remains  of  the  grandmother  of  one  of  the 
writer's  patients  were  found  in  such  a  state  of  preservation  as 
to  be  easily  recognized  after  fifty  years  of  burial.  More  re- 
cently, in  unearthing  the  remains  of  an  old  grave-yard  in  East 
Washington,  a  striking  peculiarity  was  noticed  in  the  fact  that 
many  bodies  of  young  people  buried  in  recent  years  when  taken 
up  consisted  of  a  few  blackened  bones  and  shreds  of  grave-clothes, 

'  Some    interesting  facts  by    Dr.       be    found  in  the  Boston  Med.    axid 
W.  H.  Holmes  regarding  "The  Con-       Surg.  Journal,  July  28d,  1891. 
dition  of  Bodies  Long  Buried  "  may 


392  IDENTITY — ROSSE. 

while  the  remains  of  many  older  people  buried  long  before  the 
Civil  War  were  found  in  an  excellent  state  of  preservation.  One 
of  these  was  a  Mr.  Fullin,  who  died  from  the  effects  of  a  sun- 
stroke forty  years  ago  and  was  buried  in  a  metallic  case.  An 
old  ladj'  who  attended  his  funeral  was  present  when  his  re- 
mains were  unearthed  and  said  thej"  looked  as  natural  as  when 
he  was  laid  away  in  1852.  The  features  were  well  preserved 
and  even  the  white  linen  of  the  shroud  was  unsoiled. 

Alterations  in  the  texture  of  the  bone,  such  as  that  caused 
by  dryness  and  by  diminution  in  the  proportion  of  organic 
matter,  may  be  ascertained  by  histological  examination,  and 
one  of  the  characters  of  age  may  be  furnished  b}'  taking  into 
consideration  the  specific  weight.  Placing  the  skull  at  an 
average  density  of  1,649,  that  6f  an  infant  would  be  1,515,  an 
adult  1,726,  and  that  of  old  age  1,636. 

Ascertaining  the  proportion  of  organic  and  inorganic  mat- 
ter, the  phosphates  and  carbonates,  by  chemical  means  may 
furnish  an  additional  help  in  the  interpretation  of  the  remains. 

With  all  these  diagnostic  methods  it  may  still  be  impossible 
to  establish  identity  either  absolute  or  relative,  even  where  a 
whole  skeleton  is  in  question.  The  evidence  may,  however,  be 
of  great  juridical  use  to  the  accused,  as  in  the  case  of  Van 
Solen,  tried  for  the  murder  of  Dr.  Henry  Harcourt,  where  the 
collective  facts  pointed  to  the  identification  of  a  body  dead  two 
years.  The  jury,  however,  after  a  second  trial,  were  instructed 
to  acquit  unless  they  were  certain  that  the  remains  were  Har- 
court's.  They  acquitted,  as  no  one  decided  and  apparent  fea- 
ture was  known  to  have  existed  by  which  the  remains  could  be 
identified  beyond  a  doubt.* 

Identity  in  Case  of  Entire  Skeleton  or  in  Case  of 
Isolated  Bones, 

Where  an  entire  human  skeleton  ,has  been  discovered,  the 
objects  of  inquiry  here,  as  in  the  case  of  fragments  or  remains, 
are  to  establish  the  identity  of  the  victim  and  that  of  the  author 
of  the  act,  and  to  collect  all  available  information  relative  to 
the  nature  of  the  death  and  to  the  diverse  circumstances  attend- 
ing the  commission  of  the  deed. 
'Quar.  Journal  of  Psychological  Medicine,  N.  Y.,  1869.  vol.  iii..  p.  691. 


DETERMINATION    OF    RACE.  393 

In  gathering  evidence  from  the  examination  of  the  skeleton 
or  of  isolated  bones,  with  a  view  to  find  out  the  proba,bl<^  cause 
of  death  of  the  person  of  whom  they  form  a  part,  a  great  vari- 
ety of  questions  will  arise  for  consideration,  such  as  those  relat- 
ing to  race,  stature,  age,  sex,  and  trade  or  occupation;  the 
exterior  signs  furnished  b}'  dentition ;  the  traces  of  congenital 
peculiarity  or  of  injury,  and  the  signs  of  disease  either  heredi- 
tary or  acquired. 

Determination  of  Race. 

The  question  of  race  in  connection  with  the  subject  of  iden- 
tification is  of  more  than  usual  importance  in  the  United  States, 
owing  to  our  motley  population,  composed  as  it  is  of  aboriginal 
Americans,  Chinamen,  negroes,  and  of  Europeans  and  their 
descendants.  I  well  remember  the  first  human  bones  that  I 
saw  exhumed.  They  were  discovered  in  digging  the  foun- 
dation of  a  building  near  a  kitchen-inidden  on  one  of  the 
tributaries  of  the  Chesapeake  Bay.  The  apparent  oldness  of 
the  bones  and  the  finding  of  stone  arrow-heads,  tomahawks, 
and  fragments  of  aboriginal  potterj"  in  the  immediate  vicinity 
were  additional  accessor}'  facts  that  strengthened  the  presuinp- 
tion  of  the  bones  being  those  of  a  Choptank  Indian. 

Roughly  speaking,  there  is  not  much  trouble  in  recognizing 
the  platycnemic  tibite  of  the  mound-builder,  the  skull  of  a 
Flathead  Indian,  an  Inca  skull,  a  negro  skull,  or  even  the 
skull  peculiar  to  the  lower  order  of  Irish. 

In  many  very  old  skulls  a  considerable  portion  of  hair  is 
often  found  attached.  This  of  course  may  lend  assistance  in 
the  matter  of  race  identity.  A  few  years  since  I  undertook 
at  the  Smithsonian  Institution  a  series  of  micro-photograijhs 
of  the  structure  and  arrangement  of  hair,  with  a  view  to  race 
classification  as  suggested  by  Professor  Huxley.  Various 
specimens  of  hair  from  the  yellow  races  were  compared  with 
that  of  fair  and  of  blue-ej^ed  persons,  with  the  hair  of  negroes, 
with  reindeer  hair,  and  with  the  hair-like  appendage  found  on 
the  fring}'  extremity  of  the  baleen  plates  in  the  mouth  of  a 
"  bowhead"  whale.  The  experiments,  though  far  from  satisfac- 
tory, were  sufiicientl.y  conclusive  to  enable  one  to  recognize  ap- 
proximately the  horse-like  hair  of  some  of  the  j^ellow  races, 
that  of  the  negro,  and  that  of  a  blond  Caucasian. 


394  IDENTITY — ROSSE. 

Beyond  the  forementioned  characteristics,  the  task  of  race 
recognition  from  observation  of  the  skull  is  one  of  great  diffi- 
culty and  perplexity  with  illusory  results.  A  considerable  ex- 
perience of  several  years  with  the  large  collection  of  skulls  in 
the  Army  Medical  Museum  enables  me  to  speak  advisedly  on 
this  point.' 

Although  the  technical  procedures  of  craniometry  require 
special  measurements  and  employ  an  arsenal  of  special  instru- 
ments, the  results  are  far  from  conclusive  as  regards  the  deter- 
mination of  human  types.  Time  and  space  do  not  permit  the 
mention  even  in  epitome  of  the  various  methods  most  relied 
upon  by  trained  craniologists.  Among  the  oldest  operations  of 
cephalometry,  as  well  as  the  most  incomplete,  is  the  measure- 
ment of  the  so-called  facial  angle,  which  is  employed  to  distin- 
guish the  skull  of  a  lower  order  of  animal  from  that  of  the 
negro  and  the  white  man.  This  angle,  acute  in  the  skulls  of 
the  lower  animals,  approaches  a  right  angle  as  w^e  ascend  the 
zoological  scale;  being  from  30°  to  65°  in  the  various  apes;  75° 
in  the  Mongolian ;  about  70°  in  the  negro,  and  between  80°  and 
90°  for  whites.  The  prognathous  (projecting)  jaws  of  the  negro 
cranium  are  distinctive,  as  well  as  the  shape  of  the  nasal  open- 
ing, which  in  the  black  is  an  equilateral  triangle,  while  it  is 
isosceles  in  the  white.  The  books  usually  speak  of  the  Eskimo 
skull  as  pyramidal,  which  in  point  of  fact  is  not  true.  Inspec- 
tion and  examination  of  a  large  collection  of  Eskimo  crania  has 
changed  and  greatly  modified  some  of  the  previous  notions  of 
the  conventional  Eskimo  skull.  Froin  more  than  one  hundred, 
collected  in  the  vicinity  of  Bering  Strait,"  I  find  that  the  skulls 
present  very  considerable  variations  among  themselves ;  some 
being  brachycephalic,  others  dolichocephali(\  In  many  the 
facial  angle  is  80°,  and  in  one  instance  84°,  which  exceeds  that 
observed  by  me  in  many  German  skulls.  Nor  is  the  promi- 
nence of  the  zygomatic  arches  such  a  constant  difference  in  the 
configuration  as  to  justify  one  in  speaking  of  the  skull  as  pyra- 
midal. On  the  contrary,  in  many  of  the  specimens  lines  draw^n 
from  the  most  projecting  part  of  the  zygomatic  arch  and  touch- 
ing the  sides  of  the  frontal  bone,  instead  of  forming  a  triangle 

'See    writer's    article,     "Cepha-  "-See    writer's    "Cruise    of    the 

lometry,  Craniometry,"  in  "Refer-  Corwin  "  to  Alaska  and  the  North- 

ence    Handbook    of    the    Medical  west   Arctic    Ocean,    Washington, 

Sciences. "  1883. 


DETERMINATION   OF   RACE.  395 

on  being  elongated,  might,  like  the  asymptotes  of  a  parabola, 
be  extended  to  infinitj-  and  never  meet.  The  index  of  the  fora- 
men magnum  in  these  skulls  is  about  the  same  as  that  of 
European  crania.  The  internal  capacity  shows  marked  differ- 
ence, the  cubic  contents  of  the  endocranium  averaging  that  of 
the  French  or  Germans. 

As  some  modern  writers  lay  great  stress  on  the  measure- 
ment of  the  cranial  capacitj^,  not  onty  as  an  aid  to  race  identifi- 
cation, but  as  an  adjunct  in  the  study  of  the  criminal  and 
insane  classes,  it  may  not  be  amiss  to  give  the  salient  facts 
relative  thereto. 

It  is  admitted  that  the  cranial  capacity  may  vary  with  the 
intellectual  state,  hydrocephalic  skulls,  of  course,  being  ex- 
cluded. Microcephalic  adults  give  a  figure  inferior  to  that  of 
gorillas,  some  being  as  low  as  -419  c.c.  Andaman  Islanders 
and  autochthonous  Australians  appear,  in  respect  to  cranial 
capacity,  to  be  most  badly  off.  The  capacitj-  of  an  Andaman 
has  been  found  as  low  as  1,094  c.c. ;  while  that  of  Australians 
(autochthonous)  and  of  some  American  tribes  show  an  average 
capacity  of  1,224  c.c.  in  the  normal  as  well  as  in  their  deformed 
crania.  The  cranial  capacity  increases  in  the  yellow  races  and 
attains  its  maximum  in  the  white  races.  In  the  middle  Euro- 
pean race  1,500  c.c.  maj^  be  accepted  as  the  average;  1,750  c.c. 
is  the  maximum,  and  anything  above  is  macrocephalic ;  while 
the  minimum  is  1,206  c.c,  which  is  rather  too  low  than  too 
high.  According  to  Topinard's  nomenclature  of  the  cranial 
capacity,  macrocephalic  in  the  adult  European  male  are  those 
having  a  capacity  of  1,950  c.c.  and  above;  a  large  skull  is  one 
of  1,950  to  1,650  c.c. ;  average  or  ordinary,  1,650  to  1,450  c.c.  j 
small,  1,450  to  1,150  c.c. ;  microcephalic  1,150  c.c.  and  below. 
It  would  seem  that  the  skulls  of  the  insane  are  below  the  type, 
a  measurement  of  sixteen  male  skulls  giving  an  average  of  only 
1,449  c.c.  Scotchmen  head  the  list  with  the  most  voluminous 
skulls,  and  according  to  a  tabular  statement  made  up  from 
Welcker,  Aitken,  Broca,  and  Meigs,  the  English  come  next, 
with  a  capacity  of  1,572  c.c.  Then  follow  Eskimo,  1,483  c.c. ; 
Germans,  1,448  c.c. ;  French,  1,403  to  1,461  c.c. ;  South  African 
negroes,  1,372  c.c, ;  Ancient  Peruvians,  1,361  c.c. ;  Mala}",  1,328 
c.c. ;  Mexican,  1,290  c.c. ;  Hottentot  and  Polynesian,  each  1,230 
c.c. ;  Australians,  1,364  c.c. ;  and  Nubians,  1,313  c.c.   The  cranial 


396  IDENTITY — ROSSE. 

capacity  in  man,  like  that  of  the  anthropoid  apes,  varies  accord- 
ing to  sex,  the  difference  being  so  great  that  it  is  necessary  to 
measure  separatel}'. 

In  the  troglodyte  skulls  of  prehistoric  times  the  variation  is 
not  more  than  99,5  c.c. ;  but  in  the  contemporaneous  races  the 
difference  varies  from  l-io  to  220  c.c.  French  craniologists 
usually  speak  of  the  Auvernats  as  possessing  the  highest  cere- 
bral capacit}'  (1,523  c.c),  and  mention  the  skull  of  a  Parisian 
of  1,900  c.c.  as  the  highest  known.  Some  Eskimo  skulls,  how- 
ever, measure  from  1,650  to  1,715  c.c,  and  two  eurycephalic 
Indian  skulls  in  the  anatomical  section  of  the  Army  Medical 
Museum  measure  respectively  1,785  and  1,920  c.c. 

Mr.  Havelock  Ellis,  speaking  of  the  psychic  characteristics 
of  criminals,  saj's  that  the  lower  human  races  present  a  far 
larger  proportion  of  anatomical  abnormities  than  the  ordinary 
European  population;  and  Sir  William  Turner  writes  of  the 
skulls  collected  during  the  Challenger  expedition  that  although 
their  number  is  certainly  too  limited  to  base  any  broad  general- 
ization on,  as  to  the  relative  frequency  of  occurrence  of  partic- 
ular variations  in  the  different  races,  there  is  obviously  a  larger 
proportion  of  important  variations  than  would  occur  in  a  cor- 
responding number  of  skulls  of  the  white  races.  Thus,  for 
example,  the  squamo-frontal  articulation  is  found  in  less  than 
two  per  cent  of  European  skulls,  while  it  is  found  in  twenty 
per  cent  of  negroes,  according  to  Ecker,  and  16.9  in  Australian 
skulls,  according  to  Virchow.  Again,  the  spheno-pterygoid 
foramen  is  found  in  4.8  per  cent  of  European  skulls  and  in  20 
per  cent  of  American  Indians;  30  per  cent  in  Africans;  32  per 
cent  in  Asiatics,  and  50  per  cent  in  Australians.  The  wormian 
bones  are  also  more  common  among  the  lower  races ;  as  a  rule, 
the  cranial  sutures  coalesce  much  earlier  and  the  teeth  are 
more  precocious. 

Photography,  though  of  undoubted  service  in  craniom- 
etry, has  been  applied  as  a  crucial  test  in  the  matter  of  identity 
and  found  wanting.  It  is  objected  to  on  the  ground  that  it  has 
no  character  of  precision,  and  that  photographs  of  the  skull 
have  the  common  defect  of  being  central,  not  orthogonal  pro- 
jections, such  as  anthropometry  requires.  Besides,  the  lenses 
of  cameras  are  not  uniformly  perfect.  Anatomists  know,  more- 
over, that  salient  differences  in  any  collection  of  crania  prevent 


DETERMINATION    OF    RACE.  397 

methodical  enumeration  and  constitute  tiie  stumbling-block  of 
ethnic  craniology.  Cephalometry  shows,  further,  that  dolicho- 
cephalic, mesaticephalic,  and  brachycephalic  skulls  do  not  be- 
long exclusively  to  the  white,  the  yellow,  or  the  black  race,  but 
exist  among  the  three  as  a  result  of  evolution. 

On  this  subject  Professor  Lombroso,  among  the  foremost 
contemporaneous  medico-legal  writers,  cites  the  cranial  asym- 
metry of  Pericles,  of  Romagnosi,  of  Bichat,  of  Kant,  of  Chene- 
vix,  and  of  Dante,  who  presented  an  abnormal  development  of 
the  left  parietal  bone  and  two  osteomata  on  the  frontal  bone. 
Besides,  there  is  the  Neanderthaloid  skull  of  Robert  Bruce  and 
the  ultra-dolichocephaly  noticeable  in  the  skull  of  O'Connell, 
which  contrasts  with  the  mesocephaly  of  the  Irish.  The  me- 
dian occipital  fossa  is  noticeable  in  the  skull  of  Scarpa,  while 
Volta's  skull  shows  several  characteristics  which  anthropolo- 
gists consider  to  belong  to  the  lower  races,  such  as  prominence 
of  the  styloid  apophyses,  simplicity  of  the  coronal  suture,  traces 
of  the  median  frontal  suture,  obtuse  facial  angle  (73°),  and 
moreover  the  remarkable  cranial  sclerosis,  which  at  places  at- 
tains a  thickness  of  IG  mm.  (five-eighths  of  an  inch).  Further 
mention  is  made  of  the  submicrocephaly  in  Descartes,  Tissot, 
Hoffman,  Schumann,  and  others. 

De  Quatrefages  noted  the  greatest  degree  of  macrocephaly 
in  a  lunatic,  the  next  in  a  man  of  genius.  Cranial  capacity  in 
men  of  genius  is  usually  above  the  average,  having  been  found 
as  high  as  1,6G0  c.c.  in  Thackeray,  1,830  c.c.  in  Cuvier, 
and  2,012  c.c.  in  Tourgueneff.  The  capacity  is  often  found 
above  the  average  in  insanity,  but  numerous  exceptions  occur 
in  which  it  drops  below  the  ordinary  average,  as  in  the  submi- 
crocephalic  skulls  of  Liebig,  Dollinger,  Hausmann,  Gambetta, 
Dante,  and  Shelley. 

From  what  has  just  been  said,  it  follows  that  skull  measure- 
ments for  medico-legal  purposes  have  no  more  significance  than 
the  fact  that  some  men  are  taller  and  some  shorter  than  others. 
The  medical  jurist  should,  therefore,  not  be  too  dogmatic  in 
drawing  conclusions  as  to  race  from  the  skull  alone.  To  com- 
plete the  diagnosis  in  the  matter  of  skeletal  race  peculiarity,  the 
splay  foot  of  the  negro  with  the  unusual  backward  projection  of 
the  heel-bone,  as  well  as  the  greater  relative  length  of  the  tibia 
and  of  the  radius,  may  be  taken  into  consideration.     There  are 


398  IDENTITY — KOSSE. 

other  characteristics  of  the  lower  jaw  and  of  the  facial  bones 
generally,  the  study  of  which  leads  up  to  the  realm  of  tran- 
scendental anatomy ;  so  their  further  consideration  would  hardly 
appeal  to  the  "  dispassionate,  sympathetic,  contemplative  jury" 
of  our  enlightened  countrymen. 

Determination  of  Height  or  Stature. 

When  we  have  the  entire  skeleton  to  deal  with,  the  height 
or  stature  ma}^  be  determined  with  a  reasonable  degree  of  cer- 
tainty by  allowing  from  one  to  two  inches  for  the  soft  parts. 
Most  of  the  proportions  given  in  works  on  artistic  anatomy 
approach  mathematical  exactness.  For  instance,  if  both  upper 
and  lower  extremities  are  extended  after  the  manner  of  spokes 
in  a  wheel,  and  a  point  corresponding  to  the  umbilicus  be  taken 
as  a  centre,  the  circumference  of  a  circle  described  therefrom 
should  touch  the  bottom  of  the  feet  and  the  tips  of  the  middle 
fingers.  When  the  arms  are  extended  horizontally  the  line 
included  in  the  middle-finger  tips  equals  the  height  in  the 
generality  of  men,  although  in  exceptional  cases  it  may  var}'. 
The  negro  giant,  Nelson  Pickett,  is  reported  to  have  been  eight 
feet  four  inches  high,  w^hile  his  outstretched  arms  measured 
nine  feet  from  tip  to  tip.  Ordinaril}"  the  upper  part  of  the 
symphysis  pubis  is  the  centre  of  the  bod}'.  Some  anatomists 
contend  that  this  important  point  is  realh'  below  the  symphysis 
in  the  average  man.  The  length  of  the  foot  about  equals  that 
of  the  head.  According  to  Quetelet,  its  length  is  just  one-ninth 
of  the  body  in  women,  a  little  more  than  one-ninth  in  men. 
The  conventional  representation  of  the  human  foot  with  a  sec- 
ond longer  toe  is,  according  to  Professor  Flower  (see  "  Fashion 
in  Deformity  ") ,  of  negro  origin  and  does  not  represent  M'hat  is 
most  usual  in  our  race  and  time.  Statistics  of  measurements 
made  in  England  by  several  observers  on  hundreds  of  barefooted 
children  fail  to  show  one  instance  in  which  the  second  toe  is 
the  longer.^ 

Taken  singly  the  bones  may  enable  an  approximate  estimate 
of  the  height  of  the  person  when  alive;  but  it  should  be  remem- 
bered in  connection  with  this  subject  that  the  height  is  not  a 

'  See  wi-iter's  article,  "Feet,"   iu      cal  Sciences  :"  also,  Ellis,  T.S.,  "On 
"Reference  Handbook  of  the  Medi-       the  Human  Foot. "  London,  1889. 


DETERMINATION   OF   AGE.  399 

fixed  quantity,  since  it  differs  according  to  upright  or  recum- 
bent position,  also  before  and  after  a  night's  rest.  Moreover, 
the  alleged  height  of  the  deceased  may  have  been  taken  in  boots 
and  is  probably  incorrect. 

Many  tables  of  measurements  have  been  constructed  for  the 
purpose  of  determining  the  height  from  the  dimensions  of  the 
bones;  but  the  relation  that  exists  between  the  total  height  and 
the  dimensions  of  different  bones  varies  according  to  age,  sex, 
asymmetry,  and  individual  peculiarities,  hence  the  tables  will 
not  bear  the  critical  examination  that  warrants  their  use  with 
assur^  correctness,  even  in  a  majority  of  cases.  The  femur 
is  the  bone  that  gives  the  best  results  in  these  measurements. 
Isolated  fragments  have  been  included  in  the  enumeration ;  the 
nose  and  the  middle  finger  multiplied  by  32  and  by  19  or  20 
giving  the  approximate  height.  While  the  foregoing  calcula- 
tions will  not  bear  scientific  scrutiny,  they  are  of  sufficient  im- 
portance to  be  taken  in  connection  with  other  facts  in  deter- 
mining the  probable  length  of  the  skeleton.  Among  the  most 
trustworthy  of  these  tables  are  those  of  Dr.  Dwight,  of  Harvard 
University. 

Determination  op  Age. 

The  age  is  a  still  more  difficult  matter  to  state  precisely. 
Even  during  life  one  may  be  as  much  as  ten  years  out  in  guess- 
ing tlie  age  of  an  adult,  while  the  error  may  be  from  fifteen  to 
twenty  years  in  the  case  of  a  corpse.  Dr.  Tourdes  mentions  a 
case  where  the  age  was  guessed  as  sixty  and  sixty-five  in  a 
deceased  person  aged  eighty-five. 

The  state  of  the  osseous  system  and  the  condition  and  num- 
ber of  the  teeth,  which  strictly  speaking  are  not  bone,  are 
among  the  surest  guides  in  the  determination  of  age.  The 
signs  furnished  thereby  may  vary  according  to  the  periods  of 
increase,  maturity,  and  decline. 

During  foetal  life  and  even  at  the  epoch  of  birth  the  bone 
centres  are  few.  The  distal  end  of  the  femur,  the  proximal 
end  of  the  tibia,  and  the  astragalus  are  ossified  at  birth.  Points 
of  ossification  appear  in  successive  order  of  development.  The 
exact  period  at  which  the  bones  begin  to  ossify  and  the  prog- 
ress of  bony  union  being  detailed  in  standard  works  on  anat- 
omy,   it  would   be   superfiuous   to  repeat   them   here.     These 


400  IDENTITY — ROSSE. 

changes  are,  however,  not  absokitely  certain  as  to  time  and  or- 
der, as  the  tip  of  the  acromion  process  of  the  scapula  sometimes 
remains  ununited  throughout  life ;  the  ossification  of  the  sternum 
and  of  the  costal  cartilages  is  very  uncertain,  while  the  teeth, 
like  certain  railway  trains,  are  only  due  when  they  arrive. 

From  the  character  of  the  progress  of  consolidation  of  the 
skeleton  the  age  may  be  estimated  with  a  reasonable  approach 
to  accuracy  up  to  twenty-five  or  thirty  years,  which  is  the  sta- 
tionary period  as  regards  alteration  in  the  osseous  system. 
Above  this  period  it  is  difficult  to  arrive  at  the  age.  About 
forty  the  cranial  sutures '  begin  to  disappear,  although  i^e  time 
of  the  closure  of  the  sutures  varies  within  large  limits;  the 
coccyx  becomes  consolidated ;  ossification  begins  in  the  thyroid 
cartilage  and  in  that  of  the  first  rib  (although  this  state  of  the 
rib  is  regarded  by  many  as  pathological) ;  the  lower  jaw,  which 
in  the  foetus  and  in  infancy  formed  an  obtuse  angle,  now  as- 
sumes nearly  a  right  angle.  As  senility  progresses  toward 
decrepitude,  the  bones  become  lighter  and  more  brittle,  owing 
to  fatty  atrophy,  and  their  medullary  canal  larger;  the  jaw 
returns  to  its  infantile  shape  from  loss  of  teeth  and  atrophy  of 
the  alveolar  processes ;  the  bodies  of  the  vertebrae  (according  to 
some  authorities)  bevel  off  in  front;  osteophytes  are  formed, 
and  the  neck  of  the  femur  approaches  the  horizontal.  (See 
Abortion  and  Infanticide.) 

Determination  of  Sex. 

In  the  matter  of  sex  there  should  be  no  difficulty,  after 
noting  the  proof  furnished  by  the  aggregate  characteristics  of 
both  male  and  female  skeletons.  The  points  of  contrast  between 
the  two  skeletons  are  not  so  striking  before  the  age  of  puberty. 
Generally  speaking  the  cranial  capacity  of  an  adult  woman  is 
less,  although  it  is  contended  that  since  the  great  majority  of 
males  of  the  human  species  are  taller,  heavier,  and  larger  than 
the  females,  it  follows  that  if  due  allowance  be  made  for  these 
variations,  it  will  appear  that  the  brain  capacity  of  woman  is 
relatively  very  little,  if  at  all,  inferior  to  that  of  man.  The 
mastoid  processes  of  the  female  skull  are  smaller;  the  lower 

^  See   Dwight :    "The  Closure    of      Age, "  Boston  Med.  and  Surg.  Jour- 
the   Cranial   Sutures    as  a  Sign  of      nal,  April  29th,  1890. 


DETERMINATION   OF   SEX.  401 

jaw-bone  is  relatively  smaller  and  lighter;  the  ribs  are  lighter 
and  compressed ;  the  spine  is  relatively  longer ;  the  collar  and 
shoulder  bones  and  the  sternum  '  are  smaller  and  lighter ;  there 
is  a  less  pronounced  angle  in  the  femur,  the  neck  of  which 
approaches  a  right  angle,  while  smallness  of  the  patella  in  front 
and  narrowness  of  the  articulating  surfaces  of  the  tibia  and 
femur,  which  in  man  form  the  lateral  prominences,  are  said  to 
make  the  knee-joint  in  women  a  sexual  characteristic.  But  it 
is  the  striking  contrast  in  the  pelvis  that  furnishes  a  sexual 
significance  that  is  of  greater  value  than  all  the  rest  of  the  skele- 
ton together.  From  a  glance  at  the  text-book  account  of  the 
pelvis,  it  does  not  appear  that  much  anatomical  knowledge  is 
necessary  to  identify  the  important  points  that  give  shape  to 
the  female  pelvis.  Its  greater  diameter  (except  the  vertical), 
larger  and  more  curved  sacrum  and  coccyx,  and  great  spread 
of  the  arch  of  the  pubes  are  well-nigh  incontestible  signs.  The 
differences  as  detailed  in  the  books  can  be  objected  to  only  on 
the  possibility  of  a  so-called  hermaphrodite  pelvis  in  one  of  the 
other  sex.  We  sometimes  see  a  very  large  pelvis  in  a  subject 
who  by  a  teratological  freak  became  a  man.  Masculine  char- 
acteristics are,  however,  oftener  found  in  women  than  feminine 
characteristics  in  men ;  hence  the  conclusion  that  the  presence 
of  feminine  characteristics  leaves  but  little  doubt  as  to  the  sex, 
but  that  certain  masculine  indications,  while  giving  a  great 
probability  for  the  male  sex,  are  not  absolutely  decisive.  (See 
Hermaphroditism.) 

The  finding  of  foetal  bones  around  or  about  the  supposed 
female  skeleton  is  suggestive.  It  could  not  be  inferred  from 
this  fact  alone  that  the  woman  was  or  was  not  pregnant  at  the 
time  of  death,  since  the  absence  of  foetal  remains  on  the  one 
hand  might  imply  their  entire  decomposition  in  advance  of 
those  of  the  adult;  on  the  other  hand,  the  indiscriminate  habit 
of  undertakers,  who  often  bury  still-borns  with  adults,  may 
account  for  their  presence. 

Accidental  Signs  and  Evolution  of  the  Teeth. 

The  trade  or  occupation  leaves  but  few  marks  on  the  bones 

that  are  useful  in  the  matter  of  identification.     It  is  in   the 

'  See   Dwight :  "  The   Sternum  as      Journal   of    Anatomy  and  Physrol- 
an  Index  of  Sex,  Height,  and  Age,"      ogy,  vol.  xxiv. 
26 


402  IDENTITY — ROSSE. 

recent  and  well-preserved  cadaver,  or,  better  still,  in  the  living 
subject,  that  the  professional  signs  are  of  importance.  As  a 
rule,  the  relatively  larger  scapulae  point  to  the  fact  of  a  day- 
laborer;  necrosis  of  the  lower  jaw  suggests  a  worker  in  phos- 
phorus ;  worn  and  discolored  teeth  a  user  of  tobacco,  and  auri- 
tication  of  the  teeth  might  suggest  the  previous  social  condition. 
Gold  crowns  and  fillings  and  dental  prosthesis  generally  are 
among  the  most  common  and,  at  the  same  time,  among  the  most 
useful  signs  of  identification.  By  this  means  the  bones  of  per- 
sons killed  by  Indians  on  the  Western  plains  have  been  recog- 
nized years  afterward.  The  traveller  Powell,  massacred  in 
Abyssinia,  was  recognized  in  this  way.  From  the  presence  of 
artificial  teeth  and  the  mechanical  appliances  for  fixing  them, 
dentists  may  recognize  their  own  work  beyond  a  doubt.  One 
of  the  most  common-hackneyed  of  these  cases  is  that  of  Pro- 
fessor Webster.'  Later  cases,  in  which  this  kind  of  proof  es- 
tablished convincing  and  conclusive  identification,  are  those  of 
Dr.  Cronin,  assassinated  in  Chicago  in  1889,  and  of  the  bomb- 
thrower,  Norcross.  Every  now  and  then  accounts  appear  in 
the  daily  press  of  corpses  having  been  recognized  by  inspection 
of  the  teeth.  In  Washington,  only  a  short  time  since,  the  re- 
mains of  an  unknown  man  were  exhumed  from  the  Potter's 
Field  for  judicial  reasons.  The  unrecognized  body  had  been 
found  in  the  Potomac  in  an  advanced  stage  of  decomposition. 
From  the  signs  furnished  by  the  teeth  the  remains  were  identi- 
fied as  those  of  a  person  who  had  disappeared  mysteriously  and 
under  circumstances  that  pointed  to  his  having  been  murdered 
at  a  Virginian  gambling  den,  and  his  body  thrown  into  the 
river.  In  connection  with  this  subject  the  Goss-Udderzook 
tragedy  is  of  instructive  interest. 

In  every  important  case  a  cast  of  the  mouth  should  be  taken, 
in  order  to  set  at  rest  any  question  that  may  subsequently  arise 
as  to  the  condition  of  the  jaw,  the  absence  of  teeth,  their  irreg- 
ularity or  other  dental  peculiarities.  A  cast  of  the  mouth  of 
the  deceased  in  the  Hillmon  case  showed  all  the  teeth  to  be 
regular  and  perfect,  while  it  is  alleged  that  Hillmon 's  teeth 
were  just  the  opposite.  External  signs  furnished  by  dentition 
may  assist  greatly  in  fixing  both  age  and  identity.  The  evo- 
lution of  the  human  dental  system  has  been  so  well  studied 
'  Boston  Med.  and  Surg.  Journal,  March,  1850,  toI.  xii.,  p.  162. 


ACCIDENTAL    SIGNS.  403 

from  intra-uterine  life  to  old  age  that  we  maj^  approximately 
tell  the  age,  especially  of  children,  from  the  teeth  alone.  This 
sign,  so  valuable  in  childhood,  loses  its  value  as  the  dentition 
progresses.  Elaborate  tables  and  dental  formulte  to  be  found 
elsewhere  deal  with  the  two  periods  of  dentition,  the  relative 
position  and  number  of  the  teeth,  and  the  like. 

At  birth  the  jaws  show  points  of  ossification  only ;  but  chil- 
dren are  sometimes  born  with  central  incisors,  as  the  writer  has, 
in  common  with  others,  noted  in  several  instances.  The  first 
dentition  takes  place  from  the  seventh  to  the  thirtieth  month; 
the  second  between  four  and  five  years.  In  rachitic  children 
these  periods  are  later ;  but  a  syphilitic  taint  may  hasten  their 
development.  The  twenty-eight  teeth  characterize  early  youth. 
Wisdom  teeth  appear  between  eighteen  and  twenty-five,  some- 
times as  late  as  thirty  j-ears.  The  presence  of  thirty-two  teeth 
indicates  maturity.  This  number  is  sometimes  exceeded.  Dr. 
Tidy,  in  his  work  on  "Legal  Medicine,"  reports  having  seen 
several  children  between  six  and  seven  years  with  forty-eight 
teeth.  Instances  are  recorded  of  cutting  the  teeth  at  advanced 
age,  seventy  and  one  hundred  and  eighteen  years;  of  adults 
who  have  never  had  teeth ;  of  supernumerary  teeth,  and  of  a 
third  dentition.  What  purported  to  be  a  third  dentition  came 
under  my  notice  some  years  ago,  in  the  person  of  an  old  negro 
"voodoo  doctor."  A  more  recent  case,  said  to  have  occurred  in 
an  old  man  of  seventy-four,  at  Se^anour,  Ind.,  is  reported  in 
the  Weekly  Medical  Bevietv,  St.  Louis,  Mo.,  April  IGth,  1892, 
p.  314. 

The  pathological  signs  furnished  by  the  teeth  should,  of 
course,  be  looked  upon  as  a  personal  characteristic  that  may 
lend  additional  light  in  the  question  of  identity. 

Congenital  Peculiarities,  Deformities,  and  Injuries. 

But  congenital  peculiarities  or  injuries  of  other  parts  of  the 
skeleton  are  studied  to  greater  advantage  in  determining  proof 
or  disproof  of  identity.  We  may  recognize  cranial  asymmetry ; 
the  peculiar  conformation  of  the  idiot  skull;  the  prognathous 
skull  of  the  negro ;  the  pyramidal  skull  of  some  of  the  yellow 
races,  and  the  oval  head  of  the  white  man ;  besides  the  ethnic 
artificial  deformities  already  touched  upon  in  considering  the 


404:  IDENTITY— ROSSE. 

question  of  race.  A  metopic  cranium,  a  cleft  palate,  a  deformed 
spine  or  pelvis,  a  larger  left  scapula — indicative  of  left-handed- 
ness;  a  shortened  extremity;  bowed  legs,  club  foot,  the  pres- 
ence of  extra  fingers  or  toes,  and  the  relative  length  of  the 
fingers  are  each  and  all  valuable  facts  in  judiciary  anthropology. 
In  women  of  Spanish  extraction  the  fifth  finger  is  almost  as 
long  as  the  fourth — a  fact  so  well  known  that  glove-makers 
take  advantage  of  it  in  sending  gloves  to  Mexico,  the  Antilles, 
or  to  South  America. 

An  estimate  of  the  length  of  the  hand  seems  to  be  a  matter 
of  difficult}^,  notwithstanding  the  extensive  observation  of  high 
authority.  In  the  majority  of  cases  the  ring-finger  is  longer 
than  the  index. 

Important  evidence  is  furnished  from  the  existence  of  in- 
juries such  as  fractures,  whether  old  or  recent ;  the  marks  of 
gunshot  wounds,  of  trephining,  amputation,  excision,  or  other 
surgical  operation  on  the  bones.  The  remains  of  an  old,  un- 
united fracture  in  his  left  humerus  enabled  Sir  William  Fergus- 
son  to  verify  and  settle  all  doubt  as  to  the  identity  of  the  body 
of  the  great  missionary  and  explorer,  Dr.  Livingston.'  The 
existence  of  an  injury  may  constitute  evidence  of  great  impor- 
tance to  the  accused,  as  happened  in  the  case  of  an  English  gen- 
tleman charged  with  murder,  where  the  trial  turned  on  the 
deposit  of  callus  in  a  broken  rib,  the  only  bone  produced  in 
court.  From  the  state  of  this  callus  there  could  be  no  doubt 
that  the  fracture  must  have  been  produced  about  eight  or  ten 
days  before  death,  and  could  not  have  belonged  to  the  deceased. 
There  was,  therefore,  complete  failure  of  the  identity,  and  the 
accused  was  discharged.^ 

On  the  other  hand,  circumstances  may  arise  in  which  the 
existence  or  not  of  an  injury  is  a  fact  of  great  importance  to  the 
prosecution.  Among  other  specimens  in  the  Army  Medical 
Museum  at  Washington,  the  bones  of  the  forearm  of  Wirtz, 
executed  for  inhuman  treatment  of  prisoners  during  the  Civil 
War,  show  no  remains  or  trace  of  fracture;  yet  it  was  claimed 
in  defence  at  the  trial  that  he  could  not  have  been  guilty  of  the 
atrocities  attributed  to  him,  for  the  reason  that  this  arm  was 
disabled  from  a  fracture. 

'The   British    Medical    Journal,  -  Taylor's  "Med.  Jurisprudence, " 

April  18th,  1874,  p.  527.  vol.  i.,  p.  157. 


DURATION   OF   BURIAL.  405 

Disease  of  the  bones,  whether  hereditary  or  acquired,  is 
an  essential  descriptive  element  in  reconstituting  individuality. 
Caries  and  necrosis,  rickets,  spinal  disease,  ankylosis,  and  other 
external  manifestations  of  bone  lesion  may  furnish  pointers  of 
such  value  as  often  to  be  incontestible.  They  are  so  evident  as 
not  to  require  detailed  mention ;  but  much  care  in  such  cases  is 
necessary  to  distinguish  between  disease,  decay,  and  violence, 
and.  artefacta.  The  last  may  have  resulted  from  the  axe  or 
spade  of  the  grave-digger  or  from  post-mortem  lesions  made 
at  the  necropsy,  as  in  the  remains  of  the  notorious  Beau  Hick- 
man of  Washington,  whose  body  on  being  exhumed  showed 
that  sundry  amputations  and  reamputations  had  been  made 
on  the  principal  limbs.  Having  died  in  a  public  hospital,  the 
cadaver  had  been  utilized  in  rehearsal  of  these  operations  previ- 
ous to  its  burial  in  the  Potter's  Field. 

Injuries  of  the  phalanges,  known  as  "baseball  fingers,"  are 
valuable  indications.  This  was  one  of  the  facts  of  identifica- 
tion in  the  celebrated  Cronin  case. 

Duration  of  Burial. 

The  condition  of  the  exhumed  bones  may  throw  some  light 
on  the  question  as  to  the  probable  length  of  time  thej^  have 
been  under  ground,  as  well  as  the  probable  cause  of  death.  If 
the  bones  were  entirely  denuded  of  soft  parts  we  should  hardly 
expect  them  to  be  those  of  a  corpse  buried  onl}^  three  or  four 
months  previously.  The  noting  of  such  an  injur}'  as  a  fracture 
inflicted  by  some  sharp  instrument  on  a  skull  found  in  a  cess- 
pool was  sufficient,  with  other  evidence  of  a  general  character, 
to  convict  a  prisoner  tried  at  the  Derby  Lent  Assizes  in  1847. 

In  all  cases  of  the  kind  under  consideration,  special  atten- 
tion should  be  paid  to  the  surroundings,  every  little  detail  of 
which  should  be  noted  with  the  utmost  accurac}^;  for  such 
articles  as  clothes,  jewelry,  buttons,  and  in  fact  anything  that 
may  furnish  an  inference,*  may  not  only  throw  light  on  the 
identit}'  of  the  person,  but  otherwise  assist  justice.  Cases  are 
recorded  in  which  the  identity  has  been  established  principally 
b}^  the  clothing  found  with  the  skeleton.     In  Taylor's  "  Medical 

'  Theatre-goers  are  familiar  with      tity  by  means  of  traces  of  a  perfume 
the  establishment  of  personal  iden-       in  the  play  of  "Dii^lomacy." 


406  IDENTITY — ROSSE. 

Jurisprudence"  a  case  is  mentioned  where  the  skeleton,  por- 
tions of  clothes,  buttons,  and  boots  of  a  Cornish  miner  were 
identified  after  twenty-six  years'  submersion  in  water.  Some- 
what similar  circumstances,  a  few  years  ago,  enabled  the  arctic 
explorer,  Lieutenant  Schwatka,  and  others  to  identify  the  re- 
mains of  Lieutenant  Irving,  of  the  ill-fated  Franklin  part}'. 

In  exceptional  circumstances,  as  that  of  great  cold,  for  in- 
stance, organic  remains  ma}^  be  preserved  indefinitely.  Visitors 
to  the  Junior  United  Service  Club  in  London  may  remember 
the  mammoth  bones  discovered  in  digging  the  foundation  of 
the  club-house.  Accounts  of  remarkable  preservation  of  bodies 
discovered  a  long  time  after  the  occurrence  of  Alpine  accidents, 
and  the  finding  of  well-preserved  mammoth  remains  in  the 
Siberian  ice,  are  matters  of  common  knowledge.  A  few  years 
since,  in  assisting  to  take  the  remains  of  a  mammoth  from  an 
ice  cliff  in  Escholtz  Bay,  Alaska,  I  came  across  the  skull  of  a 
musk-ox  and  the  rib  of  a  reindeer  which  showed  the  deformit}' 
and  callus  of  a  united  fracture,  yet  there  are  geological  reasons 
for  believing  that  thousands  of  years  must  have  elapsed  since 
these  remains  were  entombed  in  the  ice. 

A  precaution  to  be  taken  in  judicial  investigation  of  bones 
is  to  ascertain  whether  thej"  belong  to  more  than  one  body,  as 
they  may  have  been  put  together  with  a  view  to  deceive.  Each 
bone  should  be  examined  separately,  to  ascertain  whether  it  is 
a  right  or  left  bone  or  belongs  to  the  same  skeleton.  They 
should  be  put  together  with  intelligence  and  care,  and  if  in- 
complete parts  of  a  skeleton  they  may  be  laid  in  sand  or  putty 
and  photographed,  or  the  medical  man  may  go  further  and, 
Agassiz-like,  reconstruct  the  skeleton  from  the  fragments.  In 
the  case  of  a  fracture  the  bones  should  be  sawn  longitudinally 
in  order  to  study  the  callus. 

THE   HAIR  AND  NAILS. 

Since  the  hair  and  nails  resist  decomposition  an  unusually 
long  time,  and  are  even  believed  to  grow  after  somatic  death, 
they  may  be  considered  as  accessories  of  such  value  in  the 
question  that  occupies  us  as  to  make  it  possible  to  verify  certain 
characteristics  regarding  the  remains  of  the  cadaver  even  after 
years  of  inhumation.     For  instance,  hypertrophy  of  the  great 


THE    HAIR    AND    NAILS.  407 

toe-nail,  the  length  and  color  of  the  hair,  baldness,  or  a  long 
beard  might  furnish  evidence  of  the  beet  kind.  Both  hair  and 
nails  ma}^,  however,  change  after  death,  A  case  is  mentioned ' 
in  which  the  hair  changed  from  a  dark  brown  to  red  after 
twenty  years  of  burial.  Accredited  cases  of  the  growth  of  hair 
after  death  are  also  on  record.  Dr.  Caldwell,  of  Iowa,  states 
that  he  was  present  in  1862  at  the  exhumation  of  a  body  which 
had  been  buried  for  four  years.  He  found  that  the  coffin  had 
given  at  the  joints  and  that  the  hair  protruded  through  the 
openings.  He  had  evidence  to  show  that  the  deceased  was 
shaved  before  burial,  nevertheless  the  hair  of  the  head  measured 
eighteen  inches,  the  whiskers  eight  inches,  and  the  hair  of  the 
breast  four  to  six  inches."  Quite  recently  in  unearthing  the 
remains  of  an  old  cemetery  in  Washington,  D.  C,  a  number  of 
persons  noticed  that  when  the  body  of  a  young  girl,  supposed 
to  be  about  twelve  or  thirteen  years  of  age,  was  taken  up  it 
was  found  that  her  hair  had  grown  until  it  extended  from  her 
crown  to  her  feet.  Many  careful  observations  seem  to  prove 
the  molecular  life  of  the  hair  and  nails  after  somatic  death.  I 
suffices  to  quote  the  well-known  case  mentioned  in  Ogston's 
"Medical  Jurisprudence,"  of  several  medical  students  who  were 
brought  to  trial  for  having  in  custody  the  dead  body  of  an  idiot 
bo3\  When  found  on  the  dissecting-table  the  body  was  so 
disfigured  that  there  was  only  one  means  left  of  proving  its 
identity.  The  boy  had  a  whim  during  life  of  permitting  his 
nails  to  grow,  and  had  not  allowed  them  to  be  cut  for  many 
years  previous  to  his  death.  They  had  completely  curled  round 
the  tips  of  his  fingers  and  toes  till  the}^  had  thus  come  to  extend 
along  the  palmar  and  plantar  surfaces  in  a  strange  way.  The 
counsel  for  the  prosecution  availed  himself  of  the  knowledge  of 
this  fact,  and  his  proof  seemed  to  be  complete,  when  a  medical 
man  came  forward  and  gave  in  evidence  that  it  was  not  an 
unusual  circumstance  for  the  nails  to  grow  for  several  inches 
after  death.  This  astounding  statement  so  nonplussed  the 
judge  that  the  case  was  allowed  to  drop  as  not  proven. 

In  exceptional  cases  the  hair  may  be  green.  I  saw  a  case 
some  years  since,  for  which  no  cause  could  be  assigned,  and 
only  a  few  days  ago  I  saw  another  in  a  man  who  worked  in  a 

'  New  York  Med.  Journal,  vol.  x.,  ^  New  York  Med.  Record,  August 

p.  412.  ISth,  1877. 


408  IDENTITY — ROSSE. 

brass-foundry.  At  the  Cronin  trial  a  barber,  who  had  counted 
the  victim  among  his  customers,  recognized  the  shape  of  the 
head  and  textui-e  of  the  hair.  Subsequent  evidence  of  medical 
experts  was  conclusive  as  to  the  identity  of  hair  found  clinging 
to  a  trunk,  the  hair  cut  from  the  head  of  the  murdered  man, 
and  that  of  a  single  hair  discovered  on  a  cake  of  soap.  This 
single  strand,  being  lighter  in  color  in  some  portions  than  in 
others,  seemed  to  indicate  that  it  could  not  have  come  from  the 
head  of  the  deceased,  whose  hair  was  brown.  But  it  was  shown 
that  hair  placed  on  soap  or  other  alkaline  substances  becomes 
bleached  in  a  manner  similar  to  the  color  of  a  single  thread. 
This  evidence  of  vital  importance  linked  the  hair  found  in  the 
trunk  with  that  cut  from  Dr.  Cronin's  head,  and  went  far 
toward  proving  that  one  of  the  inurderers  had  washed  his  hands 
with  the  soap  after  the  deed  had  been  done. 

Reviewing  the  signs  furnished  by  the  osseous  system,  it 
will  be  seen  that  the  study  of  the  skeleton  alone  is  beyond  con- 
tradiction more  satisfactory  and  more  important  in  establish- 
ing identity  than  that  of  all  the  other  organs.  Consequently  a 
correct  interpretation  of  the  facts  observed  and  judicious  appli- 
cation of  the  rules  deducible  therefrom  may  in  the  matter  of  a 
human  skeleton  put  its  identity  beyond  a  reasonable  doubt. 
But  the  expert  should  remember  that  as  no  two  cases  are  just 
alike,  unexpected  questions  and  unforeseen  features  may  pre- 
sent themselves,  giving  to  each  case  merits  of  its  own.  At  best 
the  medical  man's  conclusions  will  be  probabilities,  not  certain- 
ties ;  therefore  his  expressions  of  opinion  should  be  the  more 
guarded,  as  upon  it  may  hang  the  life  of  an  innocent  man. 

IDENTIFICATION  OF  MUTILATED  REMAINS. 

Many  of  the  foregoing  remarks  on  the  identity  of  the  skele- 
ton apply  in  cases  where  mutilated  remains  or  a  portion  only 
of  the  body  has  been  recovered.  Circumstances  often  occur  in 
which  bodies  may  require  identification  after  having  been 
drowned  and  partly  eaten  by  fishes  or  crabs,  or  after  having 
been  partly  eaten  by  buzzards,  or  torn  into  fragments  by  ani- 
mals, as  has  happened  in  the  remains  of  a  dead  infant  partly 
devoured  by  a  dog,  and  in  the  case  of  a  farmer  who  died  in 
the  woods  and  was  subsequently  eaten  by  his  own  hogs.     After 


IDENTIFICATION   OF   MUTILATED    REMAINS.  409 

accidents  and  fires  where  manj^  persons  perish;  after  a  railway- 
disaster  where  bodies  have  been  mangled,  drowned,  burnt,  and 
frozen,  all  in  the  same  accident;  or  after  an  explosion  from 
steam  or  gas  or  in  a  mine,  or  from  gunpowder,  dynamite,  or 
other  substance,  the  human  remains  are  generally  in  such  a 
state  as  to  defy  all  attempts  at  recognition. 

To  dispose  of  a  dead  body  in  order  to  avoid  detection,  crimi- 
nals will  mutilate,  disfigure,  and  chop  into  fragments  the  re- 
mains, which  they  afterward  place  in  a  trunk,  a  wardrobe,  or 
throw  into  a  sewer  or  other  hiding-place.  Scarcely  a  year 
passes  that  judiciary  medicine  is  not  concerned  with  cases  of 
the  kind.  The  frequency  of  such  crimes  has  been  attributed  by 
some  to  the  so-called  contagion  of  murder;  others  offer  the 
simple  law  of  the  series  in  explanation ;  others  still  believe  that 
imitation  is  the  principal  cause.  While  there  is  no  doubt  a 
grain  of  truth  in  each  of  these,  less  philosophic  minds  will  look 
upon  such  a  beastly  proceeding  as  a  mark  of  the  complete  satis- 
faction sought  by  the  destructive  instinct. 

Why  such  things  should  be  is  of  less  concern  than  the  fact 
that  criminal  mutilation  of  the  dead  body  is  not  confined  to  any 
age  or  country'.  Though  more  frequent  in  the  last  fifteen  years, 
it  takes  up  quite  a  space  in  the  history  of  human  cruelty.  The 
violent  passion,  wrath,  and  vengeance  that  caused  the  prophet 
Isaiah  to  be  sawn  in  two  at  the  age  of  one  hundred  years  b}' 
order  of  Manasses  and  Agag  cut  into  pieces  by  Samuel  have 
not  materially  changed  in  the  days  of  Jack  the  Ripper ;  and  we 
find  such  crimes  in  antipodal  parts  of  the  world,  among  varied 
sociological  conditions,  no  matter  whether  it  be  the  North 
American  Indian,  who  scalps  and  mutilates  his  enemy  and 
places  the  severed  penis  in  the  mouth,  or  the  civilized  European, 
who  cuts  up  the  body  of  his  victim  and  serves  it  in  a  curry  at 
a  feast  of  assembled  friends.' 

This  new  point  of  judiciary  medicine  has  lately  been  elabo- 
rated by  European  writers  under  the  title  of  Depegage  Crim- 
inel,  a  term  which  applies  to  the  operation  resorted  to  by  an 
assassin  having  for  its  end  the  getting  rid  of  the  bodj^  of  the 
victim  and  to  render  more  difficult  the  establishment  of  its 
identity. 

The  cleverness  of  experts  scarcely  keeps  pace  nowada3'S 
'  Annales  d'Hygieue  Publique,  1883. 


410  IDENTITY — ROSSE. 

with  the  more  complicated  proceedings  adopted  by  criminals. 
In  fact,  at  a  trial  of  this  kind  truth  and  science  are  often  the 
under  dogs  in  a  fight,  than  which  none  in  forensic  medicine  is 
longer  and  more  embarrassing.  To  cause  a  rapid  disappearance 
of  the  proofs  of  a  homicide,  with  a  view  to  escape  the  investi- 
gations of  justice,  murderers  have  been  known  literally  to  make 
hash  of  the  victim  which  was  subsequent!}^  eaten  by  themselves 
and  others.  Gruner  relates  the  case  of  a  man  who,  having 
killed  and  cut  into  pieces  his  victim,  boiled  and  roasted  the 
fragments  and  ate  them  with  his  wife.  Such  examples,  how- 
ever, suggest  morbid  rather  than  passional  phenomena,  which 
manifestly  call  for  rigid  scrutiny  into  the  mental  state  of  the 
culprit,  who  may  be  more  of  a  lunatic  than  a  malefactor. 

In  cases  of  infanticide  new-born  children  are  sometimes  cut 
into  pieces  and  the  fragments  burnt  in  order  to  facilitate  the 
disappearance  of  the  cadaver.  There  does  not  appear  to  be, 
however,  any  well-authenticated  instance  of  the  operation  hav- 
ing been  done  on  a  living  child.  Generally  the  dismember- 
ment is  done  in  order  to  cause  more  ready  disappearance  of  the 
remains. 

The  medico-legal  problem  to  be  solved  in  cases  of  criminal 
mutilation  is  to  establish  the  identity  of  the  victim  and  that  of 
the  author  of  the  crime. 

Man}^  apparently  trivial  circumstances  may  assist  in  the 
formation  of  an  opinion  as  to  the  identity  of  the  culprit.  If 
the  victim  be  an  adult,  a  man  is  the  author  of  the  deed ;  if  an 
infant,  a  woman,  the  mother,  is  almost  always  the  guilty  one. 
The  London  Lancet  (May  30th,  18G3,  p.  G17)  reports  a  case  in 
which  the  body  of  a  child,  of  apparentl}^  four  to  six  months, 
was  found  in  the  sewage  of  a  water-closet,  minus  an  arm  cut 
off  below  the  shoulder,  presumably  that  a  vaccination-mark 
might  not  be  adduced  as  evidence.  A  young  woman  was  sus- 
pected. Several  women  deposed  having  seen  a  dusky-brown 
mother's  mark  near  the  child's  navel.  After  steeping  in  pure 
water  a  portion  of  the  skin  said  to  include  the  mark,  and  after 
washing,  the  mark  gradually  reappeared  at  the  end  of  three 
days,  perfectly  distinct.  It  was  recognized  b}^  witnesses  and 
produced  at  the  trial  as  corroborative  evidence.  The  accused 
was  found  guilty. 

In  a  case  of  infanticide  at  Tarare,  in  1881,  the  upper  ex- 


IDENTIFICATION   OF   MUTILATED    REMAINS.  411 

tremity  of  a  foetus  was  found  to  have  been  disarticulated  after 
the  manner  of  carving  the  wing  of  a  fowl.  This  having  sug- 
gested to  Dr.  Lacassagne  a  cook  as  the  author  of  the  crime,  she 
was  speedily  discovered  and  convicted.  A  few  years  later  an 
analogous  case  occurred  in  Florence  and  was  reported  by  Dr. 
A.  Montalti. 

The  instrument  used  for  mutilating  the  body  may  furnish  a 
suggestion  of  identity,  to  be  dispelled  or  affirmed  upon  further 
investigation.  The  mode  of  section  observed  in  various  in- 
stances has  led  to  the  recognition  of  a  butcher  as  the  culprit. 
An  expert  would  have  but  little  trouble  in  distinguishing  the 
hacking  and  mangling  of  a  body  from  the  careful  cutting  and 
preservation  of  muscles  and  blood-vessels  in  dissections  made 
b}'  medical  students,  whom  the  public,  by  the  way,  invariablj" 
suspect  in  cases  of  mutilation.  If  it  can  be  ascertained  that 
the  instrument  used  was  operated  either  by  a  left-handed  person 
or  by  an  ambidexter,  such  a  fact  may  prove  of  importance. 
Sometimes  the  fragments  are  tied  or  sewn  up  in  a  package. 
The  manner  in  which  the  knot  is  tied  may  indicate  the  occupa- 
tion of  the  culj^rit.  In  one  case  the  regularity  of  the  sewing 
revealed  that  it  was  the  work  of  a  woman.  Examination  of 
the  remains  of  clothing  and  of  neighboring  objects  where  the 
crime  was  committed  may  result  in  the  identification  of  the 
victim  or  of  the  murderer.  Indeed,  it  is  the  careful  noting  of 
trivial  facts  and  their  combination  that  is  so  valuable  in  all 
investigations  of  this  class.  A  compound  fact  made  up  of 
minor  facts,  which  considered  severally  would  possess  but 
little  value,  may  sometimes  solve  the  puzzle  in  a  case  where  no 
single  fact  of  conclusive  value  is  obtainable. 

Having  collected  as  much  of  the  mutilated  remains  as 
possible,  the  first  stej)  toward  identification  is  to  replace  the 
pieces  in  anatomical  order,  to  note  carefully  their  correspond- 
ence or  otherwise,  and  to  ascertain  whether  the  fragments  be- 
long to  the  same  bodj"  or  to  two  or  several  individuals.  This 
is  often  a  delicate  and  difficult  matter,  especially  where  decom- 
position is  advanced  or  where  the  horror  has  been  pushed  to 
its  utmost  limits,  as  in  the  case  of  a  fratricide  committed  in 
France  by  several  persons,  who  fragmented  the  cadaver  with  a 
saw  and  hatchet ;  boiled  the  remains  and  fed  them  to  hogs ;  and, 
after  crushing  the  bones  with  a  hammer,  threw  the  fragments 


412  IDENTITY— ROSSE. 

into  a  deep  gorge.  Again,  the  body  may  be  divided  into 
numerous  pieces,  a  hundred  or  more,  and  disposed  of  in  widely 
different  locahties,  as  in  a  pond,  a  manure-heap,  a  river,  or  a 
cesspool.  The  chopped- up  remains  of  infants  have  been  boiled 
in  lye  and  afterward  thrown  into  a  privy  or  put  in  a  barrel  of 
vinegar.  A  mother  has  also  been  known  to  cook  with  cabbage 
the  dismembered  remains  of  her  six-months'  child  and  serve  it 
at  a  meal  of  which  both  she  and  her  husband  partook.  • 

Numerous  counterparts  of  such  cases  happening  in  late 
years  could  be  cited  where  the  object  was  to  favor  the  disap- 
pearance of  the  cadaver,  and  in  which  the  establishment  of 
the  identity  turned  on  the  examination  of  some  small  part  of 
the  organism;  the  uterus,  the  spermatic  cord,  the  lobe  of  the 
ear,  the  hair,  or  the  teeth  furnishing  a  positive  demonstration 
that  led  to  judiciary  results. 

Putrefaction  goes  on  very  fast  in  a  corpse  that  has  been 
mutilated ;  but  it  is  slower  in  parts  which,  on  being  separated 
just  after  death,  have  become  bloodless  in  consequence  of  the 
hemorrhage.  After  submersion  the  outward  signs  of  putrefac- 
tion put  a  notable  obstacle  in  the  way  of  identification,  and 
after  drowning  the  body  becomes  rapidly  unrecognizable. 

Supposing  it  impossible  to  reconstitute  the  cadaver  in  all  its 
essential  parts,  it  is  always  possible,  by  following  the  instruc- 
tions already  given  for  examining  the  skeleton,  to  infer  from 
one  or  several  parts  of  the  cadaver  the  sex,  age,  height,  and 
sometimes  pathological  peculiarities  of  the  victim.  Examina- 
tion of  the  skeleton  and  teeth  is  of  capital  importance  in  an 
investigation  of  this  class.  The  indications  furnished  thereby 
having  already  been  touched  upon,  and  being  about  all  that 
we  are  justified  in  saying,  it  is  onty  necessary  to  repeat  that 
many  of  the  details  relative  to  these  special  indications  are  so 
confusing  as  to  suggest  caution  in  using  the  statistical  tables 
of  even  high  authorit}",  as  the  observations  the}'^  rest  on  are 
not  of  sufficient  extent  to  deserve  confidence. 

A  survey  of  the  head,  limbs,  trunk,  and  genital  parts  will 
give  the  most  useful  indications.  The  head,  in  fact,  is  the 
surest  index  for  justice,  and  one  that  lends  promptness  in  the 
discovery  of  the  assassin.  Typical  illustrations  of  this  occur 
in  the  Goss-Udderzook  case  and  in  the  recent  example  of  the 
bomb-thrower,  Norcross.     In  the  case  of  a  woman  murdered  by 


IDENTIFICATION   OF   MUTILATED   REMAINS.  41^ 

her  husband  at  Antwerp  in  1877  and  cut  into  one  hundred  and 
fifty-three  pieces  and  her  remains  thrown  into  a  priv}",  the 
color  of  the  hair,  the  lobule  of  a  torn  ear,  and  the  uterus  of  a 
woman  having  had  children  furnished  special  signs  that  led  to 
identity  and  condemnation.  Examination  of  the  brain  and  its 
membranes,  though  furnishing  no  -^-ery  notable  characteristics 
in  the  matter  of  identification,  may  nevertheless  be  regarded  as 
a  natural  corollary  to  that  of  the  skull.  Brain  weight,  which 
is  greatest  between  thirty  and  forty  years,  1,200  to  1,450  grams 
in  man,  1,100  to  1,500  in  woman,  diminishes  toward  the  six- 
tieth year.  It  is  said  that  the  diminution  takes  place  a  few 
years  sooner  in  the  opposite  sex.  The  estimated  loss  of  weight 
in  a  person  of  eighty  years  is  admitted  to  be  from  90  to  150 
grams.  Another  sign  of  age  is  the  tendency  to  degeneration 
found  in  the  pineal  gland,  the  cortical  substance,  the  optic  and 
striate  thalami,  and  in  the  brain  capillaries. 

The  state  of  the  eyes,  if  not  too  decomposed,  may  still  be- 
come a  sign  of  identity.  For  instance,  the  color  of  the  iris,  an 
arcus  senilis,  a  pterygium,  a  cataract  or  an  operation  for  the 
same,  an  iridectomj',  etc.,  are  signs  that  occasion  may  utilize. 

The  TRUNK  may  show,  as  it  has  in  several  instances,  incised 
wounds  that  caused  death  before  the  mutilation.  Besides,  the 
organs  therein  contained  may  by  their  weight,  dimension,  and 
tissue  alteration  indicate  the  progress  of  age  and  of  degenera- 
tion. Modifications  of  the  circulatory  and  respiratorj"  appa- 
ratus are  obviousl}'  characteristic.  As  age  advances  the  only 
organ  whose  weight  increases  with  the  number  of  years,  the 
heart,  may  become  hypertrophied  or  dilated ;  its  coronarj-  arte- 
ries may  undergo  an  alteration ;  the  pericardium  thickens,  and 
in  fact  arterial  atheroma  and  degeneration  generally  may  begin 
between  thirty-five  and  forty  j^ears.  It  should,  however,  be 
borne  in  mind  that  these  signs  of  senility  maj'  come  much  later 
or  even  not  at  all.  In  a  man  of  eightj'-four  years  Tourdes 
found  no  notable  tissue  lesion ;  in  another  of  one  hundred  and 
four  Lobstein  found  no  trace  of  ossification  of  the  arteries  of 
the  trunk  and  upper  extremities,  and  in  Thomas  Parr,  aged 
one  hundred  and  fifty-two  years,  Harvey  found  absolutely  no 
lesion  of  this  kind.  Although  toward  eighty  years  the  heart 
increases  in  weight  in  both  sexes,  the  opposite  has  been  observed 
in  exceptional  cases.     Placing  the  average  weight  of  this  organ 


414  IDENTITY — KOSSE. 

in  the  adult  at  2G6  grams  for  men,  220  for  women,  it  will  be 
found  that  progress  in  weight  gives  toward  the  eightieth  year 
an  increase  of  90  grams  for  men  and  60  for  women.  Yet  a 
case  of  cardiac  atrophy  is  reported  in  a  woman  of  eighty  whose 
heart  weighed  but  170  grams. 

Diminished  weight  of  the  lungs  becomes  accentuated  with 
years.  Especially  is  this  the  case  after  pseudo-melanosis  and 
senile  emphysema.  The  state  of  the  lungs  of  stone-cutters  and 
miners  and  various  thoracic  and  abdominal  diseases  may  like- 
wise become  signs  of  identity.  A  cirrhosed  liver,  an  en- 
larged spleen,  a  senile  kidney,  and  the  like,  are  sufficiently 
obvious  in  their  bearings  on  this  question. 

Like  the  trunk,  the  arms  and  legs,  in  cases  of  the  class 
under  consideration,  show  but  few  traces  of  disfigurement 
other  than  the  fact  of  their  having  been  disjointed.  The  man- 
ner in  which  the  sections  were  made  and  the  proceedings  em- 
ployed for  the  disarticulation  would  equally  affirm  an  expe- 
rienced hand  or  the  reverse.  Such  facts  have  of  late  years 
assisted  in  the  discovery  and  condemnation  both  of  a  farmer 
and  of  a  medical  student,  and  also  in  the  case  of  the  cook 
alreadj^  mentioned,  who  cut  off  her  child's  arm  after  the  man- 
ner of  carving  the  wing  of  a  fowl.  The  existence  of  deformity, 
injur}^,  and  disease  in  the  limbs  should,  of  course,  claim  atten- 
tion, but  their  relativity  in  an  investigation  of  the  kind  is  too 
apparent  to  require  further  comment. 

Mutilation  of  the  genital  organs  is  not  so  common.  Per- 
sons familiar  with  border  warfare  have  observed  the  savage 
custom  of  cutting  off  the  victim's  penis  and  placing  it  in  his 
mouth.  In  more  civilized  communities  the  culprits  are  gener- 
ally women  in  whom  hatred  and  ferocity  prompt  an  act  that 
marks  the  evident  satisfaction  sought  by  the  destructive  in- 
stinct. Sometimes,  however,  the  genital  organs  have  been  cut 
from  the  cadaver  of  a  woman,  presumabl}^  for  the  purpose  of 
concealing  traces  of  rape  that  may  have  preceded  the  murder. 
The  signs  furnished  by  the  female  genital  organs  as  to  virgin- 
ity, maternity,  and  the  menopause  are  so  easily  demonstrated 
at  the  necropsy  as  to  become  positive  proofs  of  identity.  The 
uterus  loses  both  in  size  and  weight  with  age.  This  along 
with  hard,  atrophied,  and  germless  ovaries  attests  the  stoppage 
of  menstruation.     The  question  of  identity  may  turn  on  the  age 


ENTIRE   CADAVER   DEAD   BUT   A   SHORT   TIME.  415 

at  which  menstruation  ceases,  as  happened  in  an  action  of 
ejectment  in  the  case  of  Doe  on  the  demise  of  Clark  vs.  Tatom. 
The  period  known  as  change  of  life,  when  the  uterus  and  ovaries 
lose  their  function,  though  placed  at  forty-five  and  fifty  years, 
is  quite  uncertain.  In  spite  of  averages,  menstruation  is  occa- 
sionally continued  to  seventy  and  upward.' 

The  signs  furnished  hy  the  genital  organs  of  the  male  are 
of  less  importance.  Atrophy  and  diminished  weight  of  the 
testicles  and  rarity  or  absence  of  the  spermatozoids  are  indica- 
tions of  senility ;  although  spermatozoids  have  been  observed  at 
ninety-four  years.  The  structure  of  the  spermatic  cord  at  dif- 
ferent periods  of  life  from  the  last  of  intra-uterine  to  the  first  of 
extra-uterine  life,  in  puberty,  and  in  old  age,  is  accompanied 
by  characteristic  modifications  of  development  and  regression, 
which  are  of  interest  on  the  question  of  medico-forensic  diagno- 
sis of  identity,  as  shown  by  Dr.  Pellacani.'' 

Congenital  deformity  of  the  genital  parts,  as  epispadias  or 
hypospadias;  marks  of  circumcision,  useful  in  India  to  iden- 
tify Mussulmans  above  eleven  years;  traces  of  disease  that 
may  have  left  extensive  cicatrices,  as  phagadenic  chancre,  sup- 
purating buboes,  etc.,  may  also  furnish  characteristics  of  evi- 
dential value. 

ENTIRE  CADAVER  DEAD  BUT  A  SHORT  TIME. 

In  the  case  of  a  body  that  has  been  dead  a  short  time  only, 
recognition  from  the  features,  even  by  the  nearest  relatives,  is 
often  a  matter  of  the  greatest  difficulty.  The  change  produced 
in  the  color  and  form  of  the  bodj",  especially  after  drowning,  is 
a  formidable  obstacle  to  identification  by  likeness  and  general 
type  of  face.  Pages  could  be  filled  with  the  mere  mention  of 
the  multiplied  instances  of  mistaken  identity  of  the  living, 
many  of  whom  have  been  punished  because  they  had  the  mis- 
fortune to  resemble  some  one  else.  How  much  more  careful, 
then,  should  be  the  medical  examination  of  the  remains  in  the 
progress  of  decay,  with  the  distortion  and  discoloration  of  the 
features,  and  the  consequent  change  or  destruction  of  the  pecu- 
liar expression  of  the  countenance  by  which  human  features  are 
usuallv  distinguished  and  identified. 

■  4 

'Med.  Gazette,  vol.  xli.,  p.  650.  -  In  a  series  of  papers  to  Riv.  Sper. 

di  freniat,  Reggio-Emilia,  1883. 


410  IDENTITY — ROSSE. 

Among  the  innumerable  instances  of  mistaken  personal 
identity  and  cases  of  resemblance  mentioned  in  history  and 
fable,  from  the  time  of  Ulysses  down  to  the  days  of  Rip  Van 
Winkle's  dog  Schneider,  it  appears  that  this  animal  is  credited 
with  more  sagacity  than  man  in  the  matter  of  recognizing  his 
master  even  after  years  of  absence.  Indeed,  recognition  by 
animals  may  be  considered  a  proof  of  identity.  Many  persons 
can  recall  instances  of  the  kind,  though  perhaps  not  so  dramatic 
as  the  one  of  the  dog  in  the  Odyssey,  who  recognized  his  mas- 
ter after  twenty  years  of  absence  and  died  immediately  there- 
after. 

As  a  matter  of  fact,  time  and  circumstances  will  so  alter 
resemblance  as  to  account  for  some  of  these  most  striking 
proofs  of  the  fallibility  of  human  testimony  that  we  see  illus- 
trated in  chapters  on  mistaken  identity.  We  easily  forget  the 
true  image  of  persons  and  things,  and  time  promptly  modifies 
them.  The  evidence  of  the  senses  may  be  so  little  trusted  in 
this  regard  that  father,  mother,  husband,  and  nurse  may  attest 
a  false  identity  in  the  case  of  their  own  children.  A  nurse  has 
been  known  to  testify  to  the  identity  of  the  severed  head  of  a 
woman  whom  thirteen  other  persons  were  sure  they  recognized 
from  characteristic  signs,  when  the  supposed  victim  put  in  an 
appearance  and  thus  attested  her  own  existence.  The  head  of 
the  unrecognized  victim  of  this  strange  controversy  is  preserved 
in  the  museum  of  the  Strassburg  Faculty. 

In  another  case  of  historical  notoriety  in  France,  forty  wit- 
nesses on  each  side  swore  to  the  personality ;  while  .in  the  cel- 
ebrated Tichbourne  trial  no  less  than  eighty-five  witnesses 
maintained  positively,  under  the  most  rigid  and  scrutinizing 
cross-examination,  that  a  certain  person  was  Sir  Roger  Charles 
Doughty  Tichbourne,  a  baronet;  at  the  same  time  a  corre- 
sponding number  were  equally  unshaken  in  their  conviction 
that  he  Avas  a  Wapping  butcher,  Arthur  Orton. 

Resemblances  often  bring  about  remarkable  coincidences. 
A  case  is  said  to  have  occurred  in  Covington,  Ky.,  where  two 
men  met,  each  the  double  of  the  other  in  form,  stature,  and 
feature,  each  having  lost  a  right  leg,  amputated  at  the  knee, 
and  ea'ch  being  blind  in  the  left  eye  from  accident. 

Puzzle  and  perplexity  are  not  confined  to  remarkable  cases 
and  judicial  errors;  for  so  many  people  are  unskilled  in  correct 


ENTIRE    CADAVER   DEAD   BUT   A    SHORT   TIME.  417 

observation  that  it  is  a  matter  of  common  occurrence  for  two 
individuals  to  be  mistaken  the  one  for  the  other.  The  writer 
for  some  years  has  f requentl}^  been  mistaken  for  a  certain  naval 
officer  he  is  said  to  resemble,  while  the  officer  in  question  has 
become  so  accustomed  to  being  called  "  Doctor"  that  he  answers 
to  the  title  without  protest. 

A  case  that  has  of  late  been  much  quoted  in  the  journals  is 
that  of  Tiggs.  What  was  supposed  to  be  his  mangled  body 
was  identified  by  his  wife,  and  further  identification  was  forth- 
coming from  one  of  his  children  and  the  employer  of  the  de- 
ceased. The  coroner  had  granted  a  certificate  for  burial,  and 
as  the  hearse  neared  the  door,  to  the  surprise  of  all  parties  the 
real  Tiggs  entered  the  house  and  gave  a  satisfactory  account 
of  his  absence. 

Most  mistakes  of  this  kind  are  the  result  of  existing  imper- 
fections in  the  average  human  mind  or  in  its  use.  So  few 
people  are  skilled  in  minute  observation  that  Lord  Mansfield's 
dictum  regarding  the  "likeness  as  an  argument  of  a  child 
being  the  son  of  a  parent "  should  be  received  with  a  certain 
degree  of  reserve,  especially  in  the  question  of  identity  from 
likeness  after  death.  In  Ogston's  "Medical  Jurisprudence"  a 
case  is  related  of  a  father  who  could  not  recognize  the  bod}^  of 
his  son  drowned  at  sea  ten  days  previously.  The  mother,  how- 
ever, identified  her  boy  from  the  existence  of  two  pimple-looking 
projections  on  the  front  of  the  chest,  which  proved  to  be  sup- 
plementary mammsB. 

As  a  rule,  the  changes  in  the  face  and  countenance  two 
weeks  after  death  are  such  that  it  is  well-nigh  impossible  to 
establish  identity  from  the  features  alone.  Yet  in  exceptional 
cases  the  external  results  of  putrefactive  decomposition  have 
been  so  delayed  or  modified  as  to  produce  very  small  changes 
in  the  features  even  after  many  years  of  burial.  Bodies  have 
been  known  to  retain  a  remarkable  state  of  preservation  for 
long  periods  in  such  circumstances  as  burial  in  a  peat  bog,  in 
the  sand  of  the  desert,  and  in  the  frozen  ground  of  cold  coun- 
tries. 

Even  photography  in  the  matter  of  identity  is  not  to  be 
trusted.  Though  an  important  accessory  to  other  evidence,  it 
is  often,   and  very  properly,   objected  to  bj^  lawyers  on  the 

ground  of  being  incompetent,  irrelevant,  and  immaterial.     The 

27 


418  IDENTITY— ROSSE. 

picture  presented  for  comparison  may  not  be  an  original  one  or 
it  may  have  been  taken  years  previously.  The  difficulty  in 
recognizing  one's  own  most  intimate  friends  from  pictures 
taken  only  a  few  years  back  is  a  matter  of  common  knowledge. 
Besides,  the  negative  from  which  the  picture  was  taken  may 
have  been  retouched  or  altered,  consequently  it  would  not  be 
the  same  as  produced  by  the  camera,  and  is,  therefore,  value- 
less as  evidence.  It  is  held  to  be  incompetent  to  prove  a  photo- 
graph by  merely  asking  a  witness  whether  or  not  he  recognizes 
the  picture  in  question  as  that  of  a  certain  person. 

In  all  cases  where  photographic  pictures  are  required  in  a 
court  of  law  the  authorities  are  that  the  artist  who  took  the 
picture  must  be  produced  and  show  that  he  took  the  picture, 
and  that  it  is  a  correct  representation  of  the  original  of  which 
it  claims  to  be  a  picture.  If  possible  the  negatives  themselves 
should  be  called  for  and  reproduced.  Dr.  Tidy  states  that  he 
has  known  a  volume  of  smoke  appear  in  a  print  as  issuing  from 
a  chimnej',  and  used  as  evidence  of  the  existence  of  a  nuisance, 
when  no  smoke  existed  in  the  original  negative.  Only  slight 
familiarity  with  the  method  of  taking  photographic  pictures 
and  the  chemistry  involved  in  the  process  suffices  to  show  that 
many  little  details  of  sensitizing,  exposing,  developing,  and 
printing  greatly  change  the  general  appearance  of  the  face. 
iSome  of  the  tricks  that  may  be  played  with  photography,  illus- 
trating its  comparative  incompetency  as  evidence  in  the  matter 
■of  personal  identification,  I  have  seen  in  a  series  of  pictures  at 
the  Department  of  Justice  in  Washington.  All  were  photo- 
graphs of  the  same  person  taken  in  such  varying  circumstances 
that  no  two  are  alike  or  recognizable  as  the  same  person,  until 
scrutiny  is  brought  to  bear  on  the  profile  of  the  nose.'  In  con- 
sidering photography  in  its  bearing  on  this  branch  of  medi- 
cine, it  must  also  be  borne  in  mind  that  a  certain  degree  of 
imperfection  arises  'from  want  of  uniformity  in  the  lenses  of 
cameras.  I  have  already  mentioned  the  want  of  precision  in 
photographing  the  skull,  the  common  defect  being  central  not 
orthogonal  projection  such  as  anthropometry  requires. 

'See   Mr.  Galton's  paper  iu  Na-       his  recent  work  on  Finger  Prints, 
ture,  June  31st,  1888,  p.  173  ;  also  in 


SURFACE    SIGNS   OF   IDENTITY.  419 


SURFACE   SIGNS  OF   IDENTITY. 

Examination  of  the  surface  of  the  skin  and  of  its  append- 
ages may  in  certain  cases  take  decisive  importance.  Valuable 
medical  proof  is  often  furnished  by  scars,  nsevi,  growths  on  the 
skin,  pock-marks,  traces  of  skin  disease  or  of  scrofula,  and  by 
the  so-called  professional  stigmata  which  would  suggest  the 
trade,  character  of  work,  or  occupation  of  the  deceased.  Thus 
cigarette-stains  on  the  fingers  of  smokers,  or  silver-stains  on 
the  hands  of  photographers,  the  horny  palm  of  the  laborer,  or 
the  soft,  delicate  hand  of  one  not  accustomed  to  work,  would 
be  indicative.  The  alterations  in  the  hand  make  it,  so  to  speak, 
the  seat  of  election ;  for  in  the  majority  of  trades  that  may  be 
mentioned  it  is  the  hand  alone  that  bears  the  principal  marks  of 
daily  work  that  indicate  the  calling.  A  case  is  recorded  of  a  per- 
son who  previously  to  his  assassination  was  lame  and  walked 
with  a  crutch.  Although  the  body  was  cut  into  fragments,  an 
examination  revealed  in  the  palm  of  the  hands  characteristic 
callosities,  showing  prolonged  use  of  support  of  this  kind.  In 
another  instance  of  criminal  mutilation  a  tattoo-mark  found  on 
the  arm  proved  an  overwhelming  charge  against  the  assassin 
and  drew  forth  his  confession.  An  accused  was  also  convicted 
of  murder  after  establishing  the  only  missing  link,  the  ques- 
tion of  identity,  which  turned  on  the  finding  of  cupping-marks 
and  a  tattoo  on  the  body  of  the  murdered  man.  Personal  iden- 
tity of  the  bodies  of  infants  has,  moreover,  been  proved  by  means 
of  a  small  blister ;  by  a  patch  of  downy  hair ;  by  the  similarity 
existing  between  two  pieces  of  thread  used  to  tie  the  umbilical 
cord;  and  by  the  severed  end  of  that  part  of  the  funis  attached 
to  the  infant  fitting  precisely  to  the  corresponding  portion  at- 
tached to  the  after-birth.  In  addition  to  these  a  methodical 
examination  may  put  in  evidence  other  f^cts  that  may  be  de- 
rived from  diverse  influences  that  leave  characteristic  traces. 

SIGNS  FURNISHED   BY  MARKS,   SCARS,   STAINS,   ETC.,   ON 

THE  SKIN. 

But  of  all  the  surface  signs,  whether  congenital  or  acquired, 
that  may  throw  light  on  the  antecedents  of  the  decedent,  birth- 
marks, freckles,  cicatrices,  tattooes,  and  the  professional  signs 


420  IDENTITY — ROSSE. 

furnish  the  best  indications.  Birth-marks  {ncevi  materni)y 
from  their  supposed  indelibiHtj',  have  given  rise  to  discussion 
at  many  celebrated  trials.  As  a  rule,  these  marks  are  perma- 
nent and  seldom  lose  their  distinctness,  though  in  exceptional 
cases  they  may  undergo  atrophy  in  the  first  years  of  life. 
Hence  testimony  as  to  the  existence  of  birth-marks  may  often 
be  uncertain  when  it  has  reference  to  a  period  a  long  way  back. 
In  a  recorded  case  of  supposed  recognition  of  a  person  having  a 
mark  of  this  kind  on  her  face,  the  alleged  victim  turned  up  and 
established  her  identity  as  well  as  the  fact  that  she  did  not  have 
the  birth-mark  attributed  to  her. 

Before  the  introduction  of  the  electrolj^tic  method  it  was 
customary  to  resort  to  cauterization,  excision,  vaccination,  and 
tattooing  the  pigmentary  spot  in  order  to  modify  or  remove 
these  congenital  marks.  Such  proceedings  usually  left  more  or 
less  of  an  indelible  scar  which  occasion  might  utilize  in  the 
matter  of  medico-legal  diagnosis.  The  traces  of  nsevi  may, 
however,  be  entirely  removed  by  electrolysis.  I  have  recently 
seen  a  nsevus  of  large  dimension  on  the  face  of  a  young  woman 
so  completely  destroyed  as  to  leave  no  trace  of  the  operation. 

The  possibility  of  the  disappearance  of  a  scar  in  such 
circumstances  depends  here,  as  it  does  in  other  instances,  on  the 
depth  of  the  wound.  A  cicatrix  being  the  result  of  a  solution 
of  continuity  in  the  derma,  the  question  arises  whether  a  wound 
that  has  divided  the  derma  without  loss  of  substance  and  healed 
by  first  intention  leaves  any  perceptible  scar.  Some  are  of  the 
opinion  that  a  cicatricial  line  persists,  but  grows  fainter  with 
time.  Histological  examination  in  a  question  of  this  kind 
might  prove  conclusive  by  showing  the  structure  of  the  fibro- 
cellular  tissue  that  constitutes  the  cicatrix.  In  the  case  of  very 
superficial  burns  or  wounds,  the  scar  may  completely  disappear 
if  the  epidermis  alone  or  the  superficial  part  of  the  derma  is 
attacked ;  on  the  other  hand,  if  there  has  been  long  suppura- 
tion or  loss  of  substance  from  ulcers,  chancres,  or  buboes, 
especially  on  the  neck,  groins,  legs,  or  genital  parts,  traces  of 
their  lesion  will  be  found.  It  may,  therefore,  be  asserted  as  a 
general  rule  that  all  scars  resulting  from  wounds  and  from  skin 
diseases  which  involve  any  loss  of  substance  are  indelible. 
A  scar  on  the  face  is  one  of  the  points  at  issue  in  the  celebrated 
Hillmon  case  already  mentioned. 


TATTOOING.  421 

As  the  matter  of  cicatrices  is  treated  in  the  section  on 
Wounds,  further  mention  here  would  be  superfluous. 

Tattooing. 

Of  all  the  scars  that  speak,  none  in  judiciary  medicine  affords 
better  signs  of  identity  by  their  permanency  and  durable  char- 
acter and  the  difficulty  of  causing  their  disappearance  than 
those  furnished  by  tattoo-marks. 

The  custom  of  tattooing  having  existed  from  the  earliest 
historical  epochs  is  of  interest  not  only  from  an  ethnological 
but  from  a  medical  and  pathological  point  of  view,  while  it  is 
of  great  importance  in  its  relation  to  medical  jurisprudence  in 
cases  of  contested  personal  identification  which  may  be  either 
established  or  refuted  b}'  this  sign.  So  trustworthy  is  it  in 
many  instances  as  to  become  a  veritable  ideograph  that  may 
indicate  the  personal  antecedents,  vocation,  social  state,  certain 
events  of  one's  life,  and  even  their  date. 

Without  going  into  the  history  of  a  subject  mentioned  b}' 
Hippocrates,  Plato,  Caesar,  and  Cicero,  it  may  be  pertinent  to 
say  that  tattooing  is  prohibited  by  the  Bible  (Leviticus  xix., 
28)  and  is  condemned  by  the  Fathers  of  the  Church,  Tertullian 
among  others,  who  gives  the  following  rather  singular  reason 
for  interdicting  its  use  among  women:  "  Cerhim  siouiis 
Spiritum  Sanctum  magis  masculis  tale  aliquid  subscribere 
potuisse  si  feminis  siibscripsisset."  {De  Virginibus  velan- 
dis.     Lutetise  Parisorum,  1G75,  f°,  p.  178.) 

In  addition  to  much  that  has  been  written  b}^  French, 
German,'  and  Italian  authors,  who  have  put  tattooing  in  an 
important  place  in  legal  medicine,  the  matter  of  tattoo-marks  a 
few  years  since  claimed  the  attention  of  the  law  courts  of  Eng- 
land, the  Chief  Justice,  Cockburn,  in  the  Tichbourne  case, 
having  described  this  species  of  evidencfe  as  of  "  vital  impor- 
tance," and  in  itself  final  and  conclusive.  This  celebrated  trial 
has  brought  to  light  about  all  the  knowledge  that  can  be  used 
in  the  investigation  of  this  sign  as  a  mark  of  identity.  Ab- 
sence of  the  tattoo-marks  in  this  case  justified  the  jury  in  their 
finding  that  the  defendant  was  not  and  could  not  be   Roger 

'  For  a  few  classical  citations  that      Zeitschrift  fiir  Ethuologie,   Berlin, 
are  more  erudite  than  profitable  see      1888,  xx. ,  j).  412. 


422  IDENTITY — ROSSE. 

Tichbourne,  whereupon  the  alleged  claimant  was  proved  to  be 
an  impostor,  found  guilty  of  perjury,  and  sentenced  to  penal 
servitude.' 

The  practice  of  tattooing  is  found  pretty  much  over  the 
world,  notably  in  the  Polynesian  Islands  and  in  some  parts  of 
Japan.  It  is,  however,  not  found  in  Russia,  being  contrary  to 
the  superstitions  of  the  people,  who  regard  a  mark  of  this  kind 
as  an  alliance  or  contract  with  evil  spirits.  Its  use  appears  to 
be  penal  only,  and  is  limited  to  Siberian  convicts.  The 
degrading  habit,  confined  to  a  low  order  of  development, 
exists  at  the  present  time  as  a  survival  of  a  superstitious  prac- 
tice of  paganism,  probably  owing  to  perversion  of  the  sexual 
instinct,  and  is  still  common  among  school-boys,  sailors,  sol- 
diers, criminals,  and  the  lowest  order  of  prostitutes  living  in 
so-called  civilized  communities.  Indeed,  unanimity  of  opinion 
among  medical  and  anthropological  writers  assigns  erotic  pas- 
sion as  the  most  frequent  cause  of  tattooing,  and  shows  the 
constant  connection  between  tattoo-marks  and  crime.  Penal 
statistics  show  the  greater  number  of  tattooed  criminals  among 
the  lowest  order,  as  those  who  have  committed  crimes  against 
the  person ;  while  the  fewest  are  found  among  swindlers  and 
forgers,  the  most  intelligent  class  of  criminals.  Even  amid 
intellectual  advancement  and  eesthetic  sensibility  far  in  ad- 
vance of  the  primitive  man,  such  as  exists  in  London  and  New 
York,  for  instance,  are  to  be  found  persons  who  make  good 
incomes  by  catering  to  this  depraved  taste  for  savage  ornamen- 
tation. Persons  who  have  been  to  Jerusalem  may  remember 
the  tattooers,  w^ho  trj"  to  induce  travellers  to  have  a  cross  tat- 
tooed on  the  arm  as  a  souvenir  of  the  pilgrimage.  If  a  writer 
in  the  Revue  des  Deux  Mondes,  15th  June,  1881,  is  to  be  be- 
lieved, it  appears  that  the  Prince  of  Wales  on  his  journey  to 
the  Holy  Land  had  a  Jerusalem  Cross  tattooed  on  his  arm, 
April  2d,  1862.  The  "  Cruise  of  the  Bacchante"  also  tells  how 
the  Duke  of  York  was  tattooed  while  in  Japan. 

The  process  is  now  rapidly  done,  an  Edison  electric  pen 
being  utilized  for  the  purpose,  and  some  of  the  wretched  mar- 

'See    "Guj-'s  Hospital  Report,"  1869.     A  later  study  on  the  medico- 

xix.,  1874;  also  "  Histoire  Medicale  legal  importance  of  tattooing  may 

de  Tatouage  "  in  Aichiv.  de  Mede-  be  found  in  Lo  Spallanzani,  Roma", 

cine    Navale,    torn.   11,    12,    Paris,  1891,  2s,  xx.,  169,  208. 


TATTOOING.  423 

tyrs  have  the  hardihood  to  be  tattooed  from  head  to  foot  with 
grotesque  designs  in  several  colors.  I  know  of  several  in- 
stances :  one  of  a  man  in  Providence,  R.  I. ;  another  of  a  Por- 
tuguese barber,  who  has  striped  poles,  razors,  brushes,  and 
other  emblems  of  his  calling  over  the  entire  body.  Another 
man  has  likenesses  of  Abe  Lincoln  and  of  Kaiser  Wilhelm  of 
Germany  on  his  respective  shins.  A  Nova  Scotian,  tattooed 
from  head  to  foot,  has  among  other  designs  that  of  "  St.  George 
and  the  Dragon  "  on  his  back ;  while  a  Texas  ranchman,  six 
feet  two  inches  tall,  underwent  the  torture  of  eight  weeks' 
profanation  of  his  body  in  order  to  appear  in  blue,  brown,  and 
red,  with  an  irreverent  image  on  his  back  of  the  Immaculate 
Conception  and  thirty-one  angels.' 

A  singular  mixture  of  erotic  and  religious  emblems  is  often 
found  among  the  varied  and  fantastic  signs  used  in  tattooing. 
I  recall  the  case  of  a  man  who  had  represented  on  his  back  a 
fox-hunt,  in  which  riders  followed  the  hounds  in  full  pursuit  of 
a  fox  about  to  take  cover  in  the  anus.  In  another  case  of  a 
man  accused  of  criminal  attempt  on  two  little  girls,  examina- 
tion of  the  sexual  organs  revealed  a  tattoo  on  the  back  of  the 
penis  representing  the  devil  with  horns  and  red  cheeks  and 
lips.  When  the  little  girls  were  asked  if  the  accused  had 
shown  them  his  virile  member,  they  answered,  "  This  man  un- 
buttoned himself  and  said  to  us:  'I  am  going  to  make  you  see 
the  devil. '  "  In  the  face  of  such  affirmations,  the  accused  con- 
fessed his  crime  and  was  condemned.  Other  tattoo  signs  of 
the  grossest  emblems  of  unnatural  passion  have  been  found 
among  low  prostitutes,  pederasts,  and  tribades. 

Statistics  founded  on  numerous  facts,  show  many  cases  of 
tattooing  of  the  penis  and  even  of  the  labia  majora  in  the  low- 
est order  of  prostitutes,  but  these  unclean  images  and  revela- 
tions of  lustful  instinct  do  not  occur  in  the  same  order  of  fre- 
quency as  those  noted  on  the  forearm,  the  deltoid,  or  the  inferior 
extremities.  So  valuable  are  these  marks  in  their  bearing  on 
the  class,  vocation,  character,  and  tastes  of  a  person  that  the 
finding  of  anchors  and  ships  would  indicate  a  sailor;  while 
flags,  sabres,  cannon,  and  other  warlike  signs  would  indicate  a 

1  According  to  Lombroso,  all  who      either  been  among  the  Pacific  Isl- 
are  tattooed  on  the  back  or  the  sex-       ands  or  sojourned  in  a  prison, 
ual  organs  have  without  exception 


424  IDENTITY — ROSSE. 

soldier,  etc.  It  is  also  noticeable  that  in  the  tattooing  prac- 
tised by  lunatics  the  image  relates  in  some  way  to  the  nature 
of  the  peculiar  form  of  mental  disease  from  which  they  suffer, 
and  it  is  chiefly  among  the  more  severe  and  incurable  cases  of 
mental  degeneration  that  these  signs  are  found.  (See  Dr.  Riva's 
article,  "Iltatuaggio  nel  Manicomio  d'Ancona,"  Cronica  del 
Manicomio  d^ Ancona,  November,  1888.) 

Almost  always  the  motive  that  prompts  these  disfigurements 
of  the  skin  is  the  result  of  impulse,  of  thoughtlessness,  or  of 
orgy,  and  almost  all  the  tattooed  come  to  repent  of  their  folly. 
The  subject  of  detatouage  has  of  late  taken  a  polemic  turn  in 
some  of  the  Continental  journals.  There  are  besides  many 
cases  on  record  of  severe  accidents  and  complications  following 
the  operation,  such  as  severe  inflammation,  erysipelas,  abscess, 
and  gangrene.  Dr.  Beuchon  gives  statistics  of  forty-seven  cases, 
in  which  four  were  followed  by  mutilation  and  eight  by  death 
either  directly  or  in  consequence  of  an  amputation.  A  certain 
proportion  of  what  is  known  as  syph  ilis  insontium  is  to  be  found 
among  the  reported  statistics  of  tattooing.  Dr.  Bispham,  of 
Philadelphia,  informs  me  that  while  at  Block] ey  Hospital  he 
saw  thirty  cases  of  syphilis  that  had  been  communicated  by  the 
same  tattooer. 

Tattooing  may  sometimes  be  accidental.  I  have  seen  a 
departmental  clerk  with  an  elongated  tattoo  on  the  back  of  his 
hand  caused  by  accidental  wounding  with  an  inked  pen.  A 
bursting  shell  during  a  naval  engagement  has  caused  a  char- 
acteristic tattoo  on  the  face  of  a  well-known  ofiScer  to  be  seen 
any  day  in  Washington.  Two  cases  of  the  bluish-black  dis- 
coloration of  the  skin  from  taking  nitrate  of  silver  have  also 
come  under  my  observation.  Both  occurred  in  medical  men, 
one  of  whom  lives  in  Florida,  the  other  in  the  District  of 
Columbia.  Silver  discolorations  of  this  kind  are  indelible,  but 
I  learn  from  one  of  these  gentlemen  that  large  doses  of  iodide 
of  potassium  cause  temporary  fading  of  the  discoloration,  which 
returns  on  stopping  the  medicine.^ 

The  indelihilitij  of  tattoo-marks  is  such  that  their  traces 
may  be  easily  recognized  in  the  cadaver,  though  in  a  somewhat 

'A  paper  by  Dr.  J.  N.  Hall  ou  with  a  report  of  cases,  may  be  found 
"The  Medico-Legal  Value  of  Pow-  in  the Trausactions  of  the  Colorado 
der-Stains    in    Gunshot   Wounds,"      Medical  Society,  1890,  xx.,  94. 


TATTOOING.  425 

advanced  stage  of  putrefaction.  The}"  have  even  been  recog- 
nized on  a  gangrenous  limb.  Sometimes,  however,  it  is  im- 
possible to  recognize  at  first  sight  whether  there  has  or  has  not 
been  a  tattoo.  A  strong  light  and  a  magnifying  glass  and  a 
microscopic  examination  of  the  neighboring  ganglia  to  detect 
the  presence  of  coloring  matter  may  assist  in  removing  doubt. 
It  has  been  found  on  the  bodies  of  tattooed  cadavers  that  the 
ganglia  are  filled  with  grains  of  coloring  matter  of  the  same 
nature  as  that  employed  in  making  the  tattoo.  Attempts  to 
remove  tattoo-marks  generally  leave  a  vicious  scar  that  is 
equally  indelible.  An  efficacious  method  is  to  tattoo  the  mark 
with  a  solution  of  tannin,  which  is  followed  by  brushing  over 
with  nitrate  of  silver.  A  red  cicatrix  follows,  and  when  the 
epidermis  separates  the  tattoo  disappears.  A  better  meihotl, 
however,  is  by  means  of  the  electric  needle  already  mentioned 
in  speaking  of  the  electrolysis  of  ngevi. 

That  a  tattoo-mark  may  disappear  by  the  effects  of  time 
and  leave  no  trace  is  a  matter  that  Cooper  reports  after  exam- 
ining the  mutilated  remains  of  a  cadaver,  and  the  statistics  of 
Caspar.  Tardieu,  and  Hutin  place  it  as  high  as  nine  in  the 
hundred.  An  officer  of  the  United  States  Revenue  Marine 
lately  called  my  attention  to  several  superficial  tattooes  on  the 
back  of  his  hand  which  had  disappeared.  The  deeper  ones, 
however,  remained.  The  spontaneous  disappearance  of  a 
tattoo  seems  to  be  possible  when  the  operation  has  been  done 
in  such  a  superficial  way  as  not  to  have  passed  the  rete  Mal- 
pighii,  or  when  the  tattooing  has  been  done  with  some  sub- 
stance not  very  tenacious,  as  vermilion,  which  appears  to  be 
easily  eliminated.  But  when  the  particles  of  coloring  matter 
penetrate  into  the  fibro-elastic  tissue  of  the  derma,  the  disap- 
pearance of  the  tattoo  is  rare. 

In  seventy-eight  individuals  tattooed  with  vermilion  alone, 
Hutin  found  eleven  upon  whom  the  tattoo  had  disappeared. 
Out  of  one  hundred  and  four  tattooes  made  with  a  single  color, 
India-ink,  writing  ink,  blue  or  back,  not  a  single  one  had  com- 
pletely disappeared.  The  results  are  identical  if  the  tattooes 
are  made  with  two  colors.  Thus  in  153  tattooes  with  vermilion 
and  India-ink,  one  instance  showed  a  fading  of  the  black,  in 
another  it  had  completel}'  disappeared,  the  red  being  well 
marked ;   twenty  times  the  red  was  partly  effaced,  the  black 


426  IDENTITY — ROSSE. 

being  well  marked ;  and  in  sixteen  cases  ths  red  had  completely- 
disappeared,  the  black  remaining  visible.' 

A  tattoo-mark  may  sometimes  be  altered,  in  which  case  it 
proves  deceptive  as  an  index.  A  workman  changing  his  trade 
seeks  to  transform  the  insignia  of  his  first  calling  into  those 
of  the  second,  or  a  criminal  in  order  to  avoid  identity  will 
make  a  change.  In  the  former  instance  the  transformation  is 
not  difficult  to  detect,  but  in  the  latter  so  much  care  is  re- 
quired to  recognize  the  change  that  penal  science  has  relegated 
the  sign  to  a  secondary  place. 

As  to  the  length  of  time  since  a  tattoo-mark  has  been  exe- 
cuted, authorities  are  that  it  is  impossible  to  tell  after  two  or 
three  weeks.  Whether  a  tattoo-mark  is  real  or  feigned  is  easily" 
settled  by  simply  washing  the  part.  This  question,  as  well  as 
that  of  the  judicial  consequences  of  such  marks,  is  hardly  per- 
tinent to  the  matter  in  hand. 

Value  of  Professional  Stigmata. 

The  so-called  professional  signs  are  of  undoubted  value  in 
the  surface  examination  for  establishing  identity,  but  it  does 
not  seem  that  their  importance  warrants  the  extreme  prolixity 
given  to  them  by  some  Continental  writers,  and  even  by  one  in 
the  city  of  Mexico,  Dr.  Jose  Ramos.  ^  For  instance,  it  is  pre- 
tended that  cataract  is  more  common  among  jewellers  because 
of  the  fineness  of  their  work;  yet  out  of  952  cataracts,  of  which 
a  record  has  been  kept,  only  two  cases  occurred  in  jewellers. 
Besides,  there  is  not  one  special  sign  or  physical  trace  left  on 
the  body  by  which  a  prostitute  may  be  knov/n,  notwithstand- 
ing the  fact  that  in  life  the  collective  appearance  would  seldom 
deceive  an  experienced  man. 

Only  in  the  case  of  sodomy,  where  anal  coitus  has  been 
frequent,  would  characteristic  signs  be  found.  On  anal  exam- 
ination of  446  prostitutes.  Dr.  Coutagne'  found  the  signs  of 
post-perineal  coitus  in  180.  He  cites  the  case  of  a  young  pros- 
titute presenting  the  astonishing  contrast  of  a  gaping  anus 
surrounded  by  characteristic  rhagades,  with  the  genital  parts 
of  an   extreme  freshness,   a  very   narrow   vagina,    and   non- 

'  Bulletin  de  I'Acad.  de  Med.,  17  -  La  Escula  de  Medicina,  Mexico, 

Janvier,  1853,  t.  xviii.,  p.  348.  1880-81.  » Lyon  Medical,  1880. 


VALUE   OF   PROFESSIONAL   STIGMATA.  427 

retracted  hymen,  constituting  by  their  reunion  a  still  firm  ring. 
A  fact  yet  more  curious  is  shown  by  a  specimen  in  the  collec- 
tion of  the  museum  of  the  laboratory  of  legal  medicine  at 
Lyons.  The  genital  organs  of  the  cadaver  of  a  woman  of 
twenty-eight  or  thirty  years  showed  a  hymen  intact  and  firm, 
but  on  examining  the  anal  region  it  was  surprising  to  find  an 
infundibuliform  deformity  with  all  the  signs  of  sodomitical 
habits,  which  of  course  rectified  the  opinion  that  had  been  made 
regarding  the  chastity  of  this  woman. 

Many  of  the  signs  enumerated  as  peculiar  to  different  call- 
ings have  no  special  anatomical  characteristic  that  is  easy  to 
distinguish  with  precision,  consequently  they  do  not  present  a 
degree  of  certainty  or  constancy  sufficient  to  be  invoked  as 
strong  medico-legal  proof  of  identity.  Moreover,  the  effects  of 
time  or  treatment  may  have  caused  alteration  or  disappearance 
of  many  of  the  signs  in  question,  which  would  at  best  be  of 
negative  rather  than  of  absolute  value. 

To  arrive  at  an  impartial  appreciation  of  the  relative  value 
of  the  professional  stigmata  as  signs  of  identity,  a  certain 
number  of  the  signs  should  be  thrown  aside  as  illusory. 
Others,  on  the  contrar}^  are  durable,  special,  and  constant,  and 
assist  in  establishing  the  identity  accordingly  as  the  lesions  or 
alterations  are  complete  or  evident;  but  it  should  be  borne  in 
mind  that  the  physical  alterations  and  chemical  modifications 
resulting  from  the  exercise  of  certain  trades  are  not  in  our 
country  so  important  from  a  medico-legal  point  of  view  as  they 
are  in  Europe,  where  class  distinctions  are  more  defined. 

VALUE   OF  STAINS  AND  DIFFERENT  IMPRINTS. 

In  the  same  manner  that  a  very  small  portion  or  fragment 
of  the  human  body  ma}"  suffice  to  establish .  the  corpus  delict i^ 
so  will  minute  remains  or  traces,  as  finger-marks,  footprints,, 
and  other  material  surroundings,  even  smells  or  traces  of  per- 
fume, be  of  great  assistance  to  justice  in  determining  the  iden- 
tity of  both  culprit  and  victim,  and  at  the  same  time  throw 
light  on  the  attendant  circumstances  of  the  deed.  The  traces 
of  a  blood}'  hand  or  foot,  smears  of  tar  or  paint,  the  various 
spots  or  stains  found  on  fabrics,  instruments,  etc.,  may  involve 
questions  of  great  nicety  the  relativity  of  which  is  apparent,. 


428  IDENTITY — ROSSE. 

especially  in  criminal  trials.  Newspapers  have  familiarized 
the  jjublic  with  many  cases  of  the  kind,  in  which  medical  ex- 
perts have  demonstrated  blood  and  other  stains  with  sufficient 
accuracy  and  positiveness  to  satisfy  a  jur}'.  The  Cronin  case 
is  a  notable  instance. 

Imprints  made  by  finger-tips  are  known  to  be  singularly 
persistent.  In  four  specimens  of  inked  digit  marks  of  Sir 
William  Herschel,  made  in  the  years  1860,  1874,  1885,  and 
1888  respectively,  though  there  was  a  difference  of  twenty -eight 
years  between  the  first  and  last,  no  difference  could  be  per- 
ceived between  the  impressions.  The  forms  of  the  spirals  re- 
mained the  same,  not  only  in  general  character,  but  in  minute 
and  measurable  details,  as  in  the  distances  from  the  centre  of 
the  spiral  and  in  the  direction  at  which  each  new  ridge  took  its 
rise.  Sir  William  Herschel  has  made  great  use  of  digit-marks 
for  the  purposes  of  legal  attestation  among  natives  of  India.' 
The  extraordinary  persistence  of  the  papillary  ridges  on  the 
inner  surface  of  the  hands  throughout  life  has  been  a  theme  of 
discussion  by  the  Royal  Society,^  and  Mr.  Galton  has  devised 
a  method  of  indexing  finger-marks.' 

The  IMPRESS  OF  A  NAKED  FOOT  covered  with  blood  maj^ 
serve  to  direct  the  investigations  of  justice.  In  a  criminal 
affair  in  France,  where  eight  individuals  were  implicated,  com- 
parative experiments  upon  the  identity  of  the  foot,  made  with 
a  view  to  determine  to  which  of  the  individuals  ought  to  be 
attributed  the  bloody  footprints  found  near  a  wardrobe,  it  was 
shown  that  a  degree  of  recognition  could  be  established  on  repro- 
ducing the  footprints  with  defibrinated  blood .  From  the  eight 
imprints  of  the  left  foot  of  each  individual,  impregnated  with 
blood,  measures  and  comparisons  could  be  made,  thus  helping 
to  establish  the  difference  or  the  resemblance  with  those  found 
near  the  wardrobe.  . 

Imprints  thus  obtained  may  be  looked  upon  as  a  kind  of 
documentary  evidence,  but  too  much  importance  should  not  be 
attached  to  them  as  articles  tending  to  prove  criminality.  The 
futility  of  such  evidence  is  shown  in  the  varying  sizes  of  differ- 
ent impressions  of  the  foot  of  the  same  person — first  in  rapid 

>Med.    Press  and  Circular,  May  May    28th,    1891.      A  medico-legal 

30tli,  1888,  p.  576.  study  of  imprints  maj' also  be  found 

'^Phil.  Trans.,  B.,  1891.  in  Archiv   d'Anthropologie  Crimi- 

3  See  Proc.   Roval  Soc,  London,  nel,  15th  July,  1891. 


VALUE   OF   STAINS   AND   DIFFERENT   IMPRINTS.  439 

progression,  secondly  by  standing,  and  third  by  slow  advance. 
The  results  ajDpear  less  sure  in  the  case  of  footprints  made  in 
mud,  sand,  dust,  or  snow.  Nevertheless  many  facts  relating 
thereto  may  be  noted  with  great  certainty.  The  question  has 
been  mooted  as  to  whether  or  not  the  impress  left  upon  the  soil 
gives  always  the  exact  dimensions  of  the  foot  that  has  made 
them.  One  side  has  contended  that  the  footprints  are  a  little 
smaller,  while  the  other  refutes  this  opinion  and  thinks  that 
they  are  a  little  larger.  The  consistency  of  the  soil,  which 
does  not  seem  to  have  entered  into  the  discussion,  doubtless  ac- 
counts for  the  small  differences  that  have  given  rise  to  this 
discrepancy  of  opinion.  The  outline  of  the  sole  of  the  foot  and 
the  relative  position  of  the  toes  are  more  or  less  neatly  designed 
as  the  ground  is  more  or  less  wet  or  soft.  The  means  employed 
for  taking  impressions  of  foot  or  other  tracks  in  mud,  etc., 
show  considerable  ingenuity  on  the  part  of  those  who  have 
elaborated  the  subject.  To  discover  foot-marks  in  mud,  pow- 
dered stearic  acid  is  spread  over  the  imprint  and  a  heat  of  at 
least  213°  is  applied  from  above.  By  this  means  a  solid  mould 
may  be  taken  of  the  imprint.  These  researches  have  been  ex- 
tended to  the  exact  reproduction  of  imprints  left  upon  snow  by 
pouring  melted  gelatine  upon  the  imprint  previously  sprinkled 
with  a  little  common  table  salt,  which  rapidly  lowers  the  tem- 
perature of  the  snow  about  fifteen  degrees  and  permits  the 
mould  to  be  taken  without  too  much  hurry.  The  study  has 
been  extended  to  the  configuration  of  the  plantar  imprints  in 
tabetics,  but  it  does  not  appear  so  far  to  be  of  much  medico- 
legal value. 

The  question  may  arise  as  to  the  length  of  time  since  the 
imprints  were  made.  This  would,  of  course,  depend  upon 
many  circumstances,  as  weather,  temperature,  and  the  like.  It 
is  a  fact  that  in  Greenland  footsteps  in  snow  have  been  recog- 
nized many  months  after  they  were  made.  A  few  summers 
ago,  on  an  arctic  expedition,  I  climbed  Cape  Lisbourne, 
Alaska,  in  company  with  another  person.  The  ground  being 
thawed  in  many  places,  our  feet  left  very  decided  imprints  in 
the  mud.  A  year  afterward  I  visited  the  same  spot,  and  on 
again  making  the  ascent  was  astonished  to  recognize  the  foot- 
steps made  the  year  before. 

Circumstances  sometimes  direct  expert  attention  to  vestiges 


430  IDENTITY — ROSSE. 

of  other  animals.  The  tracks  of  a  dog  or  of  a  horse  may  become 
the  object  of  a  medico-legal  inquest.  The  books  record  a  case 
in  which  it  was  necessary  to  ascertain  whether  a  bite  had  been 
made  by  a  large  or  a  small  dog.  This  question  was  settled  by 
producing  the  dogs  and  comparing  their  teeth  with  the  scars. 
Persons  familiar  with  border  life  know  the  importance  of  trails 
and  the  minute  observation  that  is  brought  to  bear  on  them  by 
the  experienced  frontiersman.  In  following  cattle-thieves  and 
murderers,  while  with  the  Fourth  United  States  Cavalrj^  on  the 
Rio  Grande  frontier,  I  have  known  the  peculiarity  of  a  horse's 
footprint  in  the  prairie  to  tell  a  tale  of  great  significance. 

Observation  in  this  respect  may  extend  to  such  apparently 
trivial  objects  as  the  tracks  of  wheels,  as  those  of  a  wagon,  a 
wheelbarrow,  or  a  bicycle,  or  to  the  singular  imprints  left  by 
crutches  or  a  walking-stick.  The  imprint  left  in  the  ground 
by  a  cane  usually  occurs  in  the  remarkable  order  of  every  two 
and  a  half  or  every  four  and  a  half  steps.  Investigation  of 
such  circumstances  may  result  in  material  facts  that  may  be  of 
great  assistance  in  establishing  the  relation  of  one  or  several 
persons  with  some  particular  act. 

DEFORMITIES  AND  PATHOLOGICAL  PECULIARITIES. 

The  existence  of  deformities  or  injuries  is  so  apparent  in 
serving  to  establish  identitj^  that  it  seems  almost  superfluous  to 
mention  them,  except  for  the  purpose  of  deciding  whether  the 
wounds  were  made  during  life  or  after  death.  In  the  matter 
of  gunshot  wounds  on  persons  who  took  part  in  the  late  Civil 
War,  many  of  whom  unfortunately  belong  to  the  vagrant  class 
and  are  often  found  dead,  their  wounds  sometimes  afford  excel- 
lent means  of  identification.  In  many  instances  the  multiple 
character  of  these  wounds  is  almost  incredible.  When  on  duty 
at  the  Army  Medical  Museum,  in  connection  with  the  prepara- 
tion of  the  "  Medical  and  Surgical  History  of  the  War  of  the 
Rebellion,"  I  saw  a  man  who  was  literally  wounded  from  the 
crown  of  his  head  to  the  sole  of  his  foot,  the  scars  being  fifty- 
two  in  number. 

Wounds  made  during  life  might  show  the  suggillation 
peculiar  to  bruises  or  traces  of  inflammation.  Besides,  the 
gaping  nature  of  the  lips  of  the  wound,  the  fact  of  hemorrhage 


DEFORMITIES   AND   PATHOLOGICAL   PECULIARITIES.        431 

having  taken  place  and  the  coagulation  of  the  blood,  the  infil- 
tration of  blood  into  the  cellular  tissue,  etc.,  are  surgical  facts 
that  would  leave  but  little  doubt  as  to  the  infliction  of  the 
wounds  during  life. 

The  cause  of  death  is  often  a  difficult  matter  to  determine, 
as  it  may  have  been  accidental,  suicidal,  or  the  result  of  homi- 
cide. The  causes  relating  thereto  are,  moreover,  so  many  and 
varied  that  space  and  time  compel  a  reference  to  other  headings 
of  this  work.  In  forming  an  opinion  as  to  the prohahle  date  of 
death  the  extent  of  putrefaction  is  the  chief  g-uide.  If  death 
is  quite  recent,  we  may  be  guided  by  the  post-mortem  rigidity 
or  the  extent  to  which  the  body  has  cooled.  The  march  of 
putrefactive  decomposition  would,  of  course,  be  regulated  by 
circumstances.  It  takes  place  very  rapidly  in  persons  who 
have  succumbed  to  excessive  fatigue  or  to  any  disassimilative 
excesses  or  derangement  resulting  in  ante-mortem  change  of 
the  tissues,  such  as  those  occurring  in  virulent  or  infectious  dis- 
eases. The  body  of  an  infant  decays  more  rapidly  that  that  of 
an  adult.  The  course  of  putrefactive  phenomena  is  also  influ- 
enced by  the  seasons,  the  extent  of  the  exposure  to  air,  and  to 
other  mesological  causes.  There  is  a  manifest  difference  in  the 
special  putrefactive  change  accordingly  as  a  body  is  buried  in 
the  earth,  submerged  in  a  fluid,  thrown  into  a  cesspool,  or 
buried  in  a  dung-heap. 

In  certain  cases,  especially  where  the  body  has  been  much 
mutilated,  it  may  be  desirable  to  know  whether  there  was  one 
or  several  murderers.  While  no  definite  rule  can  be  laid  down 
on  this  point,  we  are  justified  in  supposing  that  there  were  two 
or  more  assassins  when  the  body  of  the  victim  shows  both  gun- 
shot and  knife  wounds,  or  that  two  persons  were  concerned  in  the 
dismemberment  and  mutilation  of  a  body  which  shows  the 
simultaneous  presence  of  parts  skilfullj^  cut,  while  others  show 
evident  awkwardness. 

Where  there  is  more  than  one  mortal  ivound  on  the  same 
dead  body,  a  question  of  medico-legal  significance  maj^  arise. 
This  occurred  in  the  Burton  murder  case  at  Newport,  R.  I., 
in  1885,  which  gave  rise  to  discussion  of  the  following  abstract 
question :  "  Whether  it  is  jsossible  for  an  individual,  with  sui- 
cidal intent,  and  in  quick  succession,  to  inflict  a  perforating 
shot  of  the  head  and  another  of  the  chest  implicating  the  heart. 


432  IDENTITY — ROSSE. 

Or,  reversing  the  proposition,  is  it  incredible  that  a  person  bent 
on  self-destruction  can,  with  his  own  hand,  shoot  himself  in 
the  heart  and  in  the  head?" 

After  consideration  of  the  case  referred  to  and  reversal  of 
the  previous  decision  of  the  coroner,  the  supposed  suicide  jiroved 
to  be  a  homicide.  Yet  if  the  abstract  question  of  possibilities 
is  alone  regarded,  there  is  no  doubt  of  the  fact  that  a  suicide 
could  shoot  himself  in  such  manner,  both  in  the  head  and  the 
heart,  or,  changing  the  order,  of  shots  in  the  heart  and  in  the 
head.  The  number  of  cases  recorded  establishes  beyond  a 
doubt  the  feasibility  of  the  self-infliction  of  two  such  wounds,, 
and  make  it  clear  that  the  theory  of  suicide  may  be  maintained 
in  such  circumstances.' 


JUDICIAL  ANTHROPOMETRY. 

Of  late  years  the  subject  of  anthropometric  identification 
has  taken  such  a  place  before  justice  that  it  cannot  be  ignored 
by  the  medical  legist.  The  facts  of  scientific  anthropology 
have  here  been  applied  in  such  a  way  as  to  establish  with  great 
certainty  both  the  present  and  future  identity  of  individuals 
who  attempt  dissimulation  of  their  name  and  antecedents. 
The  method  used  principally  in  the  identification  of  criminals 
and  deserters  from  the  army  has  been  adopted  in  the  public 
service  ^  and  by  most  municipalities,  with  the  exception  of  New 
York,  where  the  subsequent  identification  of  persons  connected 
with  municipal  affairs  has  been  and  maybe  a  source  of  no  little 
embarrassment. 

The  system  is  based  on  three  recognitory  elements :  photog- 
raphy, anthropometric  measurements,  and  personal  markings, 
from  which  a  descriptive  list  is  made  that  gives  absolute  cer- 
tainty as  to  individual  identity. 

Owing  to  the  illusory  nature  of  photography  and  the  difii- 
culty  in  finding  the  portrait  of  any  given  individual  in  the 
large  and  constantly  increasing  collection  of  a  "  rogues'  gallery," 
the  matter  has  been  simplified  and  facilitated  by  grouping  the 
photographic  collection  according  to  the  six  anthropological 

'  See  Annual  of    the    Universal  ^  See  paragraph  II. ,  General    Or- 

Medical  Sciences,  1888,  vol.  v.,  pp.       ders     No.    33,     Adjutant-General's 
1^3-147.  Office,  April  1st,  1889. 


JUDICIAL   ANTHROPOMETRY.  433 

coefficients  of  sex,  stature,  age,  and  color  of  the  eyes.  Each  of 
these  primordial  groups  is  again  subdivided  in  such  a  way  as 
to  reduce  the  last  group  to  a  small  number,  when  the  portrait 
is  easily  found  and  verified  on  comparing  the  measurements  of 
the  head,  of  the  extended  arms,  the  length  of  the  left  foot,  and 
that  of  the  left  middle  finger. 

The  photographic  proof  for  each  individual  consists  of  two 
portraits  side  by  side,  one  of  which  is  taken  full  face,  the  other 
in  profile  of  the  I'ight  side.  On  the  back  of  the  photographic 
card  is  recorded  with  rigorous  precision  all  personal  markings 
or  peculiarities. 

The  measurements,  which  can  be  made  by  any  person  of 
average  intelligence  in  three  or  four  minutes,  are  extremely 
simple.  The  inght  ear  is  always  measured,  for  the  reason  that 
this  organ  is  always  reproduced  in  the  traditional  photograph 
which  represents  the  right  face.  Other  special  measurements 
are  taken  on  the  left  side.  The  height  sitting,  dimensions  ar  d 
character  of  the  nose,  color  of  eyes,  etc.,  are  also  noted. 

It  is  contended  that  by  these  measurements  alone  the  iden- 
tity of  an  individual  whose  face  is  not  even  known  may  be 
established  in  another  country  by  telegraph.  The  application 
of  the  system  has  proved  of  great  service  in  the  apprehension 
of  deserters  from  the  United  States  army  (when  the  authorities 
have  been  able  to  find  the  card),  while  it  is  claimed  to  have 
caused  the  disappearance  of  numerous  dissimulators  of  identity 
in  the  prisons  of  Paris.  The  police  authorities  of  that  city 
report  that  out  of  more  than  five  hundred  annual  recognitions 
by  the  foregoing  means,  not  one  mistake  has  yet  occurred.' 

To  avoid  a  possible  source  of  error  mensuration  of  the 
organs  and  the  ascertainment  of  their  form  may  be  resorted  to 
in  the  case  of  a  cadaver  that  is  much  decayed,  or  in  one  that 
has  been  purposel}^  mutilated  or  burned  by  the  assassin  in  order 
to  prevent  recognition.  A  sufficient  number  of  cases  ma}^  be 
cited  in  which  the  measurement  of  a  limb  or  a  bone  of  a 
deceased  person  known  to  have  been  lame  or  deformed  during 
life  has  resulted  in  the  establishment  of  identity  or  the  re- 
verse. 

A  mistake  may  be  prevented  in  the  case  of  supposed  mutila- 
tion of  a  drowned  body,  which  may  have  been  caused  by  the 

'  In  1892  only  three  failures  ai-e  recorded. 

28  ^ 


434  IDENTITY— ROSSE. 

screw  of  a  passing  steamer.  Other  errors  may  result  from 
carelessness,  incorrect  observation  of  signs,  and  neglect  to  fol- 
low the  ordinary  precautions  that  should  obtain  in  all  researches 
on  identity  of  the  dead  body. 

Certain  cii'cumstances  indicative  of  the  mental  state  of  the 
culprit  may  throw  light  on  the  identity,  A  person  of  unsound 
mind  would  certainly  be  suggested  as  the  perpetrator  of  such  a 
deed  as  that  of  the  woman  already  mentioned,  who  after  killing 
and  cutting  up  her  infant,  cooked  portions  of  the  remains  with 
cabbage  and  served  them  at  a  meal  of  which  she  herself  par- 
took. Equally  conclusive  should  be  the  inference  in  the  case 
cited  by  Maudsley  of  a  person  who,  for  no  ascertainable  motive, 
kills  a  little  girl,  mutilates  her  remains,  and  carefully  records 
the  fact  in  his  note-book,  with  the  remark  that  the  body  was 
hot  and  good. 

The  handwriting  left  by  the  assassin  might  also  furnish  a 
strong  presumption  as  to  the  existence  of  a  mental  lesion,  since 
the  writing  of  the  insane  is  often  characteristic,  especially  in 
the  initial  stage  of  dementia,  I  recall  the  case  of  a  former 
patient,  an  aphasia,  imprisoned  for  having  stabbed  a  man  in 
the  abdomen  and  for  having  wounded  his  wife  in  such  a  way 
that  her  arm  had  to  be  amputated.  Having  lost  the  power  to 
express  himself  phonetically,  this  man  used  a  book  and  pencil, 
but  his  writing  showed  a  degree  of  agraphia  which  alone 
Avould  establish  his  identity  beyond  a  doubt. 

While  it  is  quite  possible  that  dishonest  transactions,  and 
even  theft,  may  take  place  by  telephone  and  the  voices  of  the 
perpetrators  may  be  unmistakable  between  distant  cities,  it  is 
more  likely  that  the  phonographic  registration  of  speech  or 
other  sound  by  means  of  a  gramophone  should  become  a  matter 
of  medico-legal  investigation  and  a  possible  means  that  may 
lend  great  assistance  in  establishing  personal  identity.  Al- 
though no  precedent  may  be  cited,  it  is  not  going  into  the 
domain  of  theoretical  hypothesis  to  mention  a  discover}-  of 
such  real  scientific  certainty  that  for  years  after  death,  and 
thousands  of  miles  awaj^,  gives  an  indefinite  number  of  repro- 
ductions that  cannot  possibly  be  mistaken  b}"  any  one  familiar 
with  the  voice  before  it  had  become  "Edisonized."  Some 
gramophone  disks  lately  shown  me  from  Germany  registered 
greetings  and  messages  to  relatives  in  Washington,  who  were 


JUDICIAL    ANTHROPOMETRY.  435 

delighted  to  recognize  the  exact  reproduction  of  familiar  tones 
and  accents  of  the  Fatherland. 

So  limitless  is  the  field  of  research  in  this  direction  that 
there  is  scarcely  an  anthropological,  biological,  or  medical  dis- 
covery that  may  not  sooner  or  later  be  applied  with  profit  in 
the  investigations  of  personal  identity  where  the  combined 
efforts  of  an  attorney  and  an  expert  are  required. 

After  the  most  rigid  and  scrutinizing  anatomical  and 
material  examination  is  made  and  the  closest  inquisition  entered 
on,  it  may  often  be  impossible  to  give  a  reasonable  explanation 
for  the  cause  of  the  physical  facts  observed.  The  medical  man 
should  remember  that  his  is  the  one  great  exception  to  the  rule 
that  rigidly  excludes  opinions,  and  that  scientific  men  called  as 
witnesses  may  not  give  their  opinion  as  to  the  general  merits 
of  the  case,  but  only  as  to  the  facts  already  proved.  This  quali- 
fying rule  being  altogether  reversed  in  investigations  into 
personal  identity,  and  the  physician's  opinion  as  to  identity 
being  indispensable,  it  becomes  a  matter  of  most  serious  import 
that  this  opinion  should  be  grounded  upon  absolute  and  well- 
attested  facts. 


MEDIOO-LEGAL     DETEEMI^ATIOJ^ 


OF 


THE  TIME  OF  DEATH. 


BY 

H.  P.  LOOMIS,  A.M.,  M.D., 

Professor  of  Pathology  in  the  University  of  the  City  of  New  York;  Visiting  Physician 

and  Curator  to  BeUevue  Hospital,  Netv  York;  Pathologist  to  the 

Board  of  Health,  New  York  City;  President  New 

York  Pathological  Society,  etc.,  etc. 


MEDICO-LEGAL   DETEEMIl^ATIOi^   OF 
THE  TIME  OF  DEATH. 

SIGNS  OF  DEATH. 

The  cessation  of  respiration  and  the  absence  of  audible  heart- 
beats are  signs  generally  regarded  as  sufficient  in  themselves  to 
determine  the  reality  of  death.  But  persons  have  been  resusci- 
tated from  a  state  of  asphyxia  or  have  recovered  from  a  state  of 
catalepsy  or  lethargy  in  whom,  to  all  appearances,  the  respira- 
tory and  circulatory  processes  have  been  arrested. 

So  it  is  advisable  that  we  should  be  acquainted  with  some 
absolute  tests  of  death  which  are  not  connected  with  the  heart- 
sounds  or  the  respiration. 

It  is  well  known  that  these  important  functions,  although 
apparently  held  in  abeyance,  must  be  speedily  re-established  so 
as  to  be  recognized,  or  death  will  rapidly  follow.  This  condi- 
tion of  apparently  suspended  animation  is  seen  among  hibernat- 
ing animals ;  the  bear,  for  instance,  will  remain  for  four  or  five 
months  without  food  or  drink  in  a  state  of  lethargy — the  heart- 
action  and  respiration  hardly  appreciable.  Yet  it  will  be  suffi- 
ciently rapid  to  sustain  life  during  the  slow  metabolic  processes. 
A  number  of  well-authenticated  cases  are  reported  in  which 
persons  could  slacken  their  heart-action,  so  that  no  movement 
of  the  organ  could  be  appreciated.  The  case  of  Colonel  Town- 
send,  reported  by  Cheyne,  is  an  example.  He  possessed  the 
power  of  apparently  dying,  by  slowing  his  heart  so  that  there 
was  no  pulse  or  heart-action  discernible.  The  longest  period 
he  could  remain  in  this  inanimate  state  was  half  an  hour. 

Instances  have  occurred  in  the  new-born  child  where 
without  question  there  have  been  no  heart-beats  or  respirator}- 
movements  for  a  number  of  minutes,  the  limit  being  set  at 
five. 

These  are  exceptional  cases,  and  it  is  setting  at  defiance 

4^9 


440  TIME   OF   DEATH — LOOMIS. 

all  physiological  experience  to  suppose  that  the  heart-action  and 
respiration  can  be  suspended  entirely  when  once  they  are  estab- 
lished, for  a  period  as  long.  So,  then,  if  no  motion  of  the  heart 
occurs  during  a  period  of  five  minutes — a  period  five  times  as 
great  as  observation  warrants — death  may  be  regarded  as 
certain. 

The  respiratory  movements  of  the  chest  are  sometimes  very 
difficult  to  observe.  They  can  always  be  better  appreciated  if 
the  abdomen  and  chest  are  observed  together.  There  are  two 
methods  to  determine  whether  respiration  is  absolutely  sus- 
pended or  not.  First,  by  holding  a  mirror  in  front  of  the  open 
mouth,  observing  whether  any  moisture  collects  on  its  surface. 
Second,  by  placing  on  the  chest  a  looking-glass  or  basin  of 
water,  and  reflecting  from  it  an  image  by  artificial  or  sun  light. 
The  slightest  movement  would  be  registered  by  a  change  in 
position  of  the  image.  While  the  writer  considers  the  absence 
of  heart-beats  and  of  respiratory  movement  an  absolute  test  of 
death,  still  some  cases  may  occur  in  which  the  establishment 
of  this  test  is  very  difficult,  and  the  following  additional  tests 
may  be  employed : 

1.  Temperature  of  the  body  same  as  surrounding  air. 

2.  Intermittent  shocks  of  electricity  at  different  tensions 
passed  into  various  muscles,  giving  no  indication  whatever  of 
irritability. 

3.  Careful  movements  of  the  joints  of  the  extremities  and  of 
the  lower  jaw,  showing  that  rigor  mortis  is  found  in  several 
parts. 

4.  A  bright  needle  plunged  into  the  body  of  the  biceps  mus- 
cle (Cloquet's  needle  test)  and  left  there,  showing  on  withdrawal 
no  signs  of  oxidation. 

5.  The  opening  of  a  vein,  showing  that  the  blood  has  under- 
gone coagulation. 

6.  The  subcutaneous  injection  of  ammonia  (Monte  Verde's 
test),  causing  a  dirty-brown  stain  indicative  of  dissolution. 

7.  A  fillet  applied  to  the  veins  of  the  arm  (Richardson's  test), 
causing  no  filling  of  the  veins  on  the  distal  side  of  the  fillet. 

8.  "  Diaphanous  test :"  after  death  there  is  an  absence  of  the 
translucence  seen  in  living  people  when  the  hand  is  held  before 
a  strong  light  with  the  fingers  extended  and  in  contact. 

9.  "  Eye  test :"  after  death  there  is  a  loss  of  sensibility  of  the 


POST-MORTEM   CHANGES.  441 

eye  to  light,  loss  of  corneal  transparency,  and  the  pupil  is  not 
responsive  to  mydriatics. 


POST-MORTEM  CHANGES. 

The  human  body  after  death  undergoes  certain  changes 
which  will  be  discussed  under  the  following  heads; 

1.  Cooling  of  the  bodj\ 

2.  Flaccidity  of  the  body. 

3.  Rigor  mortis. 

4.  Changes  in  color  due  to 
(a)  Cadaveric  ecchymoses. 
(&)  Putrefaction. 

Cooling  of  the  Body. 

Immediately  after  death  there  is  a  slight  rise  of  tempera- 
ture, supposed  to  be  due  to  the  fact  that  the  metabolic  changes 
in  the  tissues  still  continue,  while  the  blood  is  no  longer  cooled 
by  passing  through  the  peripheral  capillaries  and  lungs. 

The  body  gradually  cools  and  reaches  the  temperature  of  the 
surrounding  air  in  from  fifteen  to  twenty  hours;  this  is  the 
ordinary  course,  but  the  time  may  be  influenced  by  a  variety  of 
causes,  such  as  the  condition  of  the  bod}'  at  the  time  of  death, 
manner  of  death,  and  circumstances  under  which  the  body  has 
been  placed. 

In  certain  diseases,  as  yellow  fever,  rheumatism,  chorea,  and 
tetanus,  the  temperature  of  the  body  has  been  known  to  rise  as 
high  as  104°  F.  and  remain  so  for  a  time.  Again,  it  has  been  ob- 
served that  when  death  has  taken  place  suddenh',  as  from  acci- 
dent, apoplex}',  or  acute  disease,  the  body  retains  its  heat  for  a 
long  time.  The  bodies  of  persons  dying  from  hanging,  electro- 
cution, suffocation,  or  poisoning  b}'  carbon  dioxide,  do  not  gen- 
erally cool  for  from  twentj'-four  to  forty-eight  hours,  and  cases 
are  recorded  where  three  da3's  have  elapsed  before  the  body  was 
completely  cold.  On  the  other  hand,  bodies  dead  from  chronic 
wasting  diseases  or  severe  hemorrhage  cool  very  rapidlj'",  even 
in  four  or  five  hours. 

In  determining  the  temperature  of  a  dead  body  the  hand  is 
not  a  reliable  guide:  the  thermometer  should  always  be  used. 


442  TIME   OF   DEATH — LOOMIS. 


Flaccidity. 

The  first  effect  of  death  from  any  cause  is  general  relaxation 
of  the  entire  muscular  system.  The  lower  jaw  drops,  the  eye- 
lids lose  their  tension,  the  limbs  are  flabby  and  soft,  and  the 
joints  become  flexible. 

In  from  five  to  six  hours  after  death,  and  generally  while 
the  body  is  in  the  act  of  cooling,  the  muscles  of  the  limbs  are 
observed  to  become  hard  and  contracted,  the  joints  stiff,  and  the 
body  unyielding.  Muscles  which  are  contracted  in  the  death- 
agony  do  not  necessarily  become  relaxed  at  any  time. 

The  muscular  tissues  in  the  dead  body  can  be  considered 
as  passing  through  three  stages:  (1)  flaccid  but  contractile, 
(2)  rigid  and  incapable  of  contraction,  (3)  relaxed  and  incapable 
of  further  contractility. 

Rigor  Mortis. 

This  is  sometimes  called  cadaveric  rigidity ,  and  occurs  gen- 
erally within  six  hours  after  death  and  disappears  within  six- 
teen to  twenty-four  hours.  Many  theories  have  been  advanced 
to  account  for  it,  but  the  most  probable  one  is  that  the  rigidity 
is  due  to  the  coagulation  of  the  myosin  in  the  muscles  by  the 
weak  acids  which  are  no  longer  removed  from  the  system ;  the 
muscles  always  give  an  acid  reaction  and  are  opaque  instead  of 
transparent;  after  putrefaction  has  set  in  ammonia  is  devel- 
oped, the  myosin  dissolved,  and  so  flaccidity  results. 

Rigor  mortis  occurs  first  in  the  muscles  of  tlie  eyelid,  next  the 
muscles  of  the  lower  jaw  and  neck  are  affected,  then  the  chest 
and  upper  extremities;  afterward  it  gradually  progresses  from 
above  downward,  affecting  the  muscles  of  the  abdomen  and 
lower  limbs.  The  rigidity  disappears  in  the  same  sequence. 
The  period  after  death  when  rigor  mortis  manifests  itself, 
together  with  its  duration,  is  chiefly  dependent  upon  the  previ- 
ous degree  of  muscular  exhaustion.  Brown-Sequard  has  dem- 
onstrated that  the  greater  the  degree  of  muscular  irritability  at 
the  time  of  death,  the  later  the  cadaveric  rigidity  sets  in  and 
the  longer  it  lasts.  He  has  also  shown  that  the  later  putrefac- 
tion sets  in,  the  more  slowly  it  progresses. 


FLACCIDITY — RIGOR   MORTIS.  443 

The  more  robust  the  individual  and  the  shorter  the  disease, 
the  more  marked  and  persistent  is  this  muscular  rigidity.  It 
has  been  noticed  that  the  bodies  of  soldiers  killed  in  the  begin- 
ning of  an  engagement  become  rigid  slowly,  and  those  killed 
late  quickly.  This  explains  the  reason  why  bodies  are  some- 
times found  on  the  battle-field  in  a  kneeling  or  sitting  posture 
with  weapons  in  hand. 

If  the  rigidity  of  rigor  mortis  after  it  is  once  complete  is 
overcome,  as  in  bending  an  arm,  it  never  returns ;  but  if  in- 
complete it  may  return.  This  will  serve  at  times  to  distinguish 
real  death  from  catalepsy  and  its  allied  conditions.  While  the 
average  duration  of  rigor  mortis  has  been  given  as  sixteen  to 
twenty-four  hours,  iu  must  be  remembered  that  in  some  cases 
it  has  been  known  to  last  only  a  few  hours,  as  in  death  by  light- 
ning or  by  electrocution.  In  other  cases  it  has  persisted  for 
seven  and  fourteen  daj^s. 

This  long  continuance  of  rigor  mortis  has  been  noted  in 
death  from  strychnine  and  other  spinal  poisons,  in  suffocation, 
and  in  poisoning  by  veratrum  viride. 

Atmospheric  conditions  modify  to  a  large  extent  the  dura- 
tion of  rigor  mortis.  Dry,  cold  air  causes  it  to  last  for  a  long 
time,  while  warm,  moist  air  shortens  its  duration.  Also  im- 
mersion in  cold  water  brings  on  rigor  mortis  quickly  and 
lengthens  its  duration. 

Cadaveric  Ecchymosis — Cadaveric  Lividity  or 
Hypostasis. 

Within  a  few  hours  after  death  the  skin  of  the  body,  which 
is  of  a  pale,  ashy-gray  color,  becomes  covered  b}^  extensive 
patches  of  a  bluish  or  purple  color,  which  are  most  pronounced 
and  are  first  seen  on  the  back  part  of  the  trunk,  head  extremi- 
ties, ears,  face,  and  neck,  and  are  due  to  the  blood,  before  coag- 
ulating, settling  in  the  most  dependent  parts  of  the  body,  pro- 
ducing a  mottling  of  the  surface  with  irregular  livid  patches. 
There  is  also  a  stagnation  of  blood  in  the  capillary  vessels,  es- 
pecially in  those  in  the  upper  layer  of  the  true  skin  or  in  the 
space  between  the  cuticle  and  cutis.  The  discoloration  con- 
tinues to  increase  until  the  body  is  cold,  when  it  is  entirely 
arrested.     Later  on,  just  before  putrefaction  begins,  the  color 


444  TIME   OF   DEATH — LOOMIS. 

deepens,  and  the  change  appears  to  proceed  from  an  infiltration 
of  blood  pigment  into  the  dependent  parts  of  the  body. 

At  the  same  time  the  discolorations  are  appearing  on  the 
surface  of  the  body,  internal  hypostasis  is  also  taking  place, 
most  marked  in  the  dependent  portions  of  the  brain,  lungs,  in- 
testines, kidneys,  and  spinal  cord. 

This  condition  in  the  brain  may  be  mistaken  for  so-called 
congestive  apoplexy ;  in  the  lungs,  for  pulmonary  apoplex}'  or 
tlie  first  stage  of  lobar  pneumonia;  in  the  intestines  and  spinal 
meninges,  for  the  beginning  of  inflammatory  changes. 

The  position  of  these  hypostases  will  afford  the  best  correc- 
tion for  this  possible  error.  The  appearances  presented  by 
cadaveric  ecchymoses  have  often  been  mistaken  for  the  effects 
of  violence  applied  during  life.  Innocent  persons  have  been 
accused  and  tried  for  murder  or  manslaughter  on  charges  after- 
ward proved  to  be  groundless.  Therefore  it  is  of  the  utmost 
importance  that  the  medical  jurist  should  be  able  to  distinguish 
between  ante-mortem  and  post-mortem  ecchymoses. 

The  following  are  the  points  of  difference : 

1.  Situation.  Post-mortem  ecchymoses  are  seen  on  that  por- 
tion of  the  body  which  has  been  most  dependent,  generally  the 
posterior  aspect,  and  they  involve  principally  the  superficial 
layers  of  the  true  skin ;  ante-mortem  ecchymoses  may  occur  any- 
where, and  generally  the  deeper  tissues  are  discolored. 

2.  In  cadaveric  lividity  there  is  no  elevation  of  the  skin 
and  the  discoloration  terminates  abruptly. 

3.  After  cutting  into  the  tissues  where  an  ecchymosis  has 
been  produced  by  violence,  the  blood  without  the  vessels  is  free 
in  the  tissue ;  this  is  not  so  in  cadaveric  ecchymosis. 

4.  Post-mortem  ecchymoses  are  very  extensive,  ante-mortem 
generally  limited  in  area. 

A  peculiar  appearance  of  cadaveric  lividity  is  observed  in 
bodies  which  have  been  wrapped  in  a  sheet  and  allowed  to  cool 
or  that  have  cooled  in  their  clothing.  It  occurs  in  the  form  of 
bands  or  stripes  over  the  whole  surface,  and  often  gives  an 
appearance  as  of  a  person  flogged.  The  explanation  of  this 
appearance  is  that  the  congestion  of  the  vessels  takes  place  in 
the  interstices  of  the  folds,  while  the  parts  compressed  remain 
whole.  The  unbroken  condition  of  the  cuticle,  together  with 
the  other  characteristics  just  mentioned,  are  sufficient  to  distin- 


CADAVERIC   ECCHYMOSIS — PUTREFACTION.  445 

guish  these  ecchymoses  from  those  produced  by  violence.  While 
cadaveric  lividity  is  seen  in  all  bodies  after  death,  it  is  espe- 
cially pronounced  in  those  persons  who  have  died  suddenly  in 
full  health  or  by  violence,  as  from  apoplexy,  hanging,  drown- 
ing, or  suffocation.  It  is  very  slight  in  the  bodies  of  those 
who  have  died  from  hemorrhage  or  anaemia. 

The  time  at  which  cadaveric  lividity  appears  varies  greatly. 
Casper,  who  has  investigated  the  subject  thoroughly,  sets  the 
time  at  from  twelve  to  fifteen  hours  after  death. 

Putrefaction. 

At  a  period  varying  from  a  few  hours  to  three  days  after 
death,  certain  changes  are  seen  in  the  human  body  which  show 
that  putrefaction  has  commenced.  A  change  of  color  appears 
first  upon  the  middle  of  the  abdomen  and  gradually  spreads 
over  the  rest  of  the  body ;  it  is  first  pale  green,  which  gradually 
deepens,  and  finally  becomes  purplish  or  brown.  This  change 
in  color  is  due  to  the  action  on  the  haemoglobin  of  the  gases 
developed  by  decomposition.  Similar  discoloration  makes  its 
appearance  on  the  chest,  between  the  ribs,  on  the  face,  the  neck, 
the  legs,  and  lastly  on  the  arms,  where  it  is  more  marked  along 
the  large  venous  trunks,  and  has  sometimes  been  mistaken  for 
marks  of  violence.  The  eyeballs  become  flaccid,  and  if  exposed 
to  the  air  the  conjunctiva  and  cornea  become  dry  and  brown. 
Gases  are  formed,  not  only  in  the  hollow  organs  of  the  abdo- 
men but  also  in  the  skin.  Those  developed  in  the  cavities  of 
the  head  and  face  force  frothy,  reddish  fluid  or  mucus  from  the 
mouth  and  nostrils,  and  may  cause  swelling  of  the  features  and 
protrusion  of  the  eyes  and  tongue.  It  must  be  remembered 
that  the  gases  while  producing  distention  of  the  abdomen  may 
also  cause  changes  in  the  position  of  the  blood  and  slight  dis- 
placement of  the  organs;  they  may  also  force  undigested  food 
into  the  mouth  and  into  the  larynx,  and  so  lead  to  suspicion  of 
death  from  suffocation. 

As  putrefaction  advances,  after  a  period  of  five  or  six  days 
the  entire  surface  of  the  body  becomes  green  or  brown,  the  cuti- 
cle becomes  loose  and  easily  detached ;  the  tissues  flaccid  and 
often  bathed  in  a  reddish  serum  in  such  situations  as  the  neck, 
the  groin,  and  the  back  part  of  the  scalp.     The  thorax  and 


446  TIME  OF  DEATH — LOOMIS. 

abdomen  become  enormously  distended,  the  features  distorted 
and  scarcely  recognizable,  and  the  hair  and  nails  loosened. 
Beyond  this,  it  is  impossible  to  follow  the  changes  leading  to 
disintegration  with  any  degree  of  certainty.  The  changes 
which  I  have  just  described  as  produced  by  putrefaction  are  the 
ordinary  ones  seen  in  a  body  exposed  to  the  air  at  a  moderate 
temperature,  but  it  must  be  remembered  that  the  time  and 
rapidity  of  the  development  of  these  changes  may  be  influenced 
by  a  large  number  of  factors,  and  that  they  are  of  very  little 
importance  in  estimating  the  time  of  death.  I  have  seen  bodies 
buried  two  months  that  have  shown  fewer  of  the  changes  pro- 
duced by  putrefaction  than  others  dead  but  a  week. 

The  appearance  of  a  body  buried  in  a  coffin  will  be  as 
follows  after  a  period  varying  from  a  few  months  to  one  or  two 
years.  The  soft  tissues  will  have  become  dry  and  brown  and 
the  face  and  limbs  covered  with  a  soft  white  fungus.  Hard 
white  crystalline  deposits  of  calcium  phosphate  will  be  found 
on  the  surface  of  the  soft  organs,  and  when  found  on  the  surface 
of  the  stomach  care  should  be  taken  not  to  confound  them  with 
the  effects  of  poison.  .  In  time  the  viscera  become  so  mixed  to- 
gether that  it  is  diflficult  to  distinguish  them.  For  the  most  part 
the  changes  that  take  place  in  a  body  buried  in  a  coffin  are 
similar,  but  much  slower,  to  those  that  occur  if  the  bod}'  is 
exposed  to  the  air  or  buried  in  soil.  Even  under  apparently 
identical  circumstances  the  most  varied  results  have  been  ob- 
served, so  it  is  not  possible  for  a  medical  jurist  to  fix  a  definite 
period  of  death  or  the  time  of  burial  from  the  appearance  of  an 
exhumed  body.  For  example,  Taylor  records  a  case  where  after 
thirtj'-four  years'  interment  an  entire  and  perfect  skeleton  was 
discovered,  surrounded  by  traces  of  shroud  and  coffin,  while  in 
an  adjoining  grave  all  that  remained  of  a  body  that  had  been 
dead  twenty-five  years  were  the  long  bones  and  base  of  the 
skull.  In  one  case  a  body  was  found  well  preserved  after  six 
years'  burial  and  in  another  after  even  thirty  j'ears'  interment. 

This  brings  us  next  to  a  consideration  of  those  factors  that 
favor  or  retard  decomposition. 


CIRCUMSTANCES   FAVORING   PUTREFACTION.  447 


Circumstances  Favoring  Putrefaction. 

1.  Temperature. — Putrefaction  advances  most  rapidly  at 
a  temperature  between  70°  and  100°  F,  It  may  commence  at 
any  temperature  above  50°  F.,  but  it  is  wholly  arrested  at  32°  F. 
So  one  day's  exposure  of  a  body  in  summer  may  effect  greater 
changes  than  one  week  in  winter.  After  freezing,  putrefaction 
takes  place  with  unusual  rapidity  upon  the  thawing  out  of  the 
body.     A  temperature  of  212°  F.  stops  all  putrefactive  changes. 

2.  Moisture. — Putrefaction  takes  place  only  in  the  presence 
of  moisture.  An  excess  of  moisture,  however,  seems  to  retard 
the  process,  possibly  by  cutting  off  the  excess  of  air.  The  vis- 
cera according  to  the  amount  of  water  they  contain  decompose 
at  different  times  after  death — for  instance,  the  brain  and  eye 
rapidly,  the  bones  and  hair  slowly. 

3.  Air. — Exposure  to  air  favors  decomposition  by  carr3^ing 
to  the  body  the  micro-organisms  which  bring  about  putrefaction ; 
absence  of  air  soon  arrests  the  changes :  this  is  seen  in  bodies 
hermetically  sealed  in  lead  coffins,  which  remain  unchanged  for 
a  long  period  of  time.  Moist  rather  than  dr}"  air  favors  putre- 
faction by  lessening  evaporation.  Air  in  motion  retards  while 
still  air  favors  the  change. 

It  is  to  be  remembered  that  a  body  decomposes  more  rapidly 
in  air  than  in  water  or  after  burial.  Given  similar  tempera- 
tures, the  amount  of  putrefaction  observed  in  a  body  dead  one 
week  and  exposed  to  the  air  will  about  correspond  to  one  sub- 
merged in  water  for  two  weeks  or  buried  in  a  deep  grave  for 
eight  weeks. 

4.  Age. — The  bodies  of  children  decompose  much  more 
rapidly  than  those  of  adults ;  foetuses  still  more  rapidly.  Aged 
bodies  decompose  slowh",  probabl}^  on  account  of  a  deficienc}^  of 
moisture.  Fat  and  flabbj"  bodies  decompose  quickly  for  the 
same  reason. 

5.  Cause  of  Death. — In  cases  of  sudden  death,  as  from 
accident  or  violence,  the  body  decomposes  more  rapidly  than 
when  death  results  from  disease.  Putrefaction  sets  in  early  in 
death  from  the  infectious  fevers,  such  as  typhus,  pyaemia,  and 
typhoid  fever,  also  in  death  from  suffocation  bj'  smoke  or  coal 
gas,  by  strangulation  or  after  narcotic  poisoning.     Those  parts 


448  TIME  OF  DEATH — LOOMIS. 

of  a  body  which  are  the  seat  of  bruises,  wounds,  or  fractures 
decompose  rapidl}' ;  this  is  especially  seen  in  parts  after  a  sur- 
gical operation. 

G.  Manner  of  Burial. — When  a  body  is  buried  in  low 
ground  in  a  damp,  swampy,  clay  soil,  decomposition  advances 
rapidlj',  as  also  when  the  grave  is  shallow  so  the  body  can  be 
exposed  to  constant  variations  of  temperature.  A  porous  soil 
impregnated  with  animal  and  vegetable  matter  favors  putrefac- 
tion, as  also  burying  a  body  without  clothes  or  coffin ;  this  is 
especially  seen  where  infants  have  been  thrown  into  the  ground 
and  loosely  covered  with  earth. 

Circumstances  Retarding  Putrefaction. 

1.  The  Temperature.— Below  32°  F.  and  above  212°  F. 
putrefaction  is  entirely  arrested.  The  rapiditj"  of  the  change 
considerably  lessens  as  the  temperature  advances  above  100°  F. 
A  remarkable  instance  of  the  preservative  power  of  cold  is 
given  by  Adolph  Erman,  who  states  that  the  body  of  Prince 
Menschikoff,  a  favorite  of  Peter  the  Great,  exhumed  after 
ninety-two  years'  burial  in  frozen  soil,  had  undergone  hardly 
any  change.  Buried  in  hot  sand  as  is  seen  in  the  desert,  a  body 
putrefies  very  slowly  and  generally  becomes  mummified. 

2.  Moisture. — Absence  of  moisture  retards  decomposition. 
In  the  dry  air  of  the  desert  bodies  have  been  preserved  for  a 
long  period  of  time. 

3.  Air. — If  access  of  air  to  a  body  be  prevented  in  any  way 
by  its  inclosure  in  a  coffin,  by  closel}^  fitting  clothes,  or  by  com- 
plete immersion  in  water,  putrefaction  is  retarded. 

4.  Age. — Adults  and  old  people  decompose  more  slowly 
than  children.  Males  are  said  to  change  less  rapidly  than 
females,  lean  people  than  fleshy  ones. 

5.  Cause  of  Death.— Putrefaction  is  delayed  after  death 
from  chronic  diseases  unless  they  are  associated  with  dropsy. 
Poisoning  by  alcohol,  chloroform,  strychnine,  and  arsenic  retard 
putrefaction.  In  the  latter  case  the  putrefactive  changes  seem 
to  stop  after  they  have  once  commenced,  and  often  a  result  very 
similar  to  mummification  is  seen.  Death  from  the  mineral 
acids,  especially  sulphuric,  appears  to  delay  putrefaction. 

6.  Manner  of  Burial.— Putrefaction  is  retarded  by  burial 


CIRCUMSTANCES   RETAEDING   PUTREFACTION.  449 

a  short  time  after  death;  by  interment  on  high  ground,  in  dry, 
sandy,  or  gravelly  soil ;  by  having  the  grave  deep,  over  six  feet 
in  depth  if  possible ;  by  the  body  being  well  wrapped  and  secured 
in  a  tight  coffin,  a  lead  one  being  the  best  in  this  respect.  Lime 
or  charcoal  applied  freely  about  a  body  will  retard  decomposi- 
tion, as  will  also  injection  of  the  body  through  the  arteries  with 
such  substances  as  arsenic,  chloride  of  zinc,  or  antimony.  The 
ultimate  effect  of  putrefaction  is  to  reduce  all  bodies  to  inor- 
ganic compounds,  chiefly  water,  ammonia,  and  carbon  dioxide. 
Three  conditions  are  necessary  for  its  establishment,  (1)  a  given 
temperature,  (2)  moisture,  (3)  free  access  of  air. 

The  order  in  which  the  various  organs  and  tissues  undergo 
decomposition,  as  given  by  Casper,  who  has  investigated  the 
subject  carefully,  is  as  follows:  Trachea  and  larynx,  brain  of 
infants,  stomach  and  intestines,  spleen,  omentum  and  mesen- 
tery, liver,  brain  of  adults,  heart  and  lungs,  kidney,  bladder 
and  oesophagus,  pancreas,  large  vessels,  and  last  of  all  the 
uterus. 

As  the  result  of  putrefaction,  fluids,  generally  blood-stained, 
collect  in  the  serous  cavities  of  the  body,  and  should  not  be  con- 
founded with  serous  effusions  occurring  during  life.  So  also 
the  softening  of  the  organs  and  tissue  resulting  from  decompo- 
sition should  be  carefully  distinguished  from  those  resulting 
from  inflammation.  These  cadaveric  softenings  are  most  fre- 
quently found  in  the  brain,  spleen,  and  gastro-intestinal  mucous 
membrane.  Inflammatory  softenings  are  differentiated  by  being 
rarely  general  but  almost  always  limited,  by  the  substance  of 
the  inflamed  part  being  infiltrated  with  serum  or  pus  and 
showing  traces  of  vascular  injection.  In  doubtful  cases  the 
pathologist  should  have  recourse  to  the  microscope. 

As  the  result  of  putrefaction,  various  changes  take  place  in 

the  mucous  membrane  of  the  stomach   and  intestines  which 

simulate  the  effects  of  poisons.     The  color  of  the  stomach  varies 

from  red,  which  becomes  brighter  on  exposure  to  the  air,  to  a 

brown,  slate,  or  livid  purple.     We  can  only  presume  that  these 

color-changes  are  the  result  of  irritant  poisons  when  they  are 

found  in  non-dependent  parts  and  parts  not  in  contact  with 

organs  engorged  with  blood,  when  they  are  seen  soon  after 

death,   and  when  the  membrane  is  covered  with  coagulated 

blood,  mucus,  or  flakes  of  membrane. 
29 


450  TIME   OP   DEATH — LOOMIS. 


Effects  on  Putrefaction  of  Submersion  in  Water. 

There  are  certain  modifications  of  the  putrefactive  changes 
when  bodies  have  been  submerged  in  water.  In  the  first  place, 
the  changes  are  much  less  rapid ;  they  often  do  not  show  them- 
selves until  about  the  twelfth  day,  and  then  as  discolorations 
appearing  generally  first  about  the  ears  and  temples,  then  on 
the  face,  from  which  they  spread  to  the  neck,  shoulders,  chest, 
abdomen,  and  finally  to  the  legs.  This  is  almost  the  inverse 
order  of  the  putrefactive  changes  in  bodies  exposed  to  the  air. 
As  a  result  of  the  formation  of  gases,  the  body  in  a  short  time 
becomes  buoyant ;  after  floating  on  the  surface  of  the  water  for 
a  time,  the  gases  escape  and  the  body  sinks,  rising  a  second 
time  when  fresh  gas  has  formed. 

The  rapidity  of  decomposition  in  water  varies,  being  most 
rapid  when  the  temperature  is  from  G4°  to  68°  F.  Stagnant  as 
well  as  shallow  water  favors  putrefaction.  If  a  body  becomes 
coated  with  mud  the  change  is  delayed.  Submersion  in  a  cess- 
pool also  retards  it,  and  the  conditions  are  such  as  to  favor  the 
formation  of  adipocere. 

After  a  body  has  been  removed  froin  the  water  an  exposure 
of  a  very  few  hours  to  the  air  causes  rapid  decomposition,  so 
that  in  twenty-four  hours  more  marked  changes  may  occur  than 
would  have  resulted  from  a  fortnight's  longer  submersion.  The 
face  soon  becomes  bloated  and  black,  so  that  identification  is 
well-nigh  impossible.  It  is  quite  important  in  medico-legal 
cases  to  estimate  the  time  which  has  elapsed  since  death  in 
bodies  found  submersed  in  water.  The  following  are  the  vari- 
ous changes  ordinarily  seen  at  different  periods  of  time,  as 
estimated  by  Devergie,  who  has  especially  investigated  the 
subject : 

First  Four  or  Five  Days. — Little  change :  rigor  mortis 
may  persist,  particularly  if  the  water  is  cold. 

Fourth  or  Fifth  Day.— Skin  of  the  ball  of  the  thumb  and 
little  finger,  also  the  lateral  surface  of  the  fingers,  begins  to 
whiten.  This  whitening  gradually  extends  to  the  palms  of  the 
hands  and  soles  of  the  feet.  The  skin  of  the  face  will  appear 
softened  and  of  a  more  faded  white  than  the  rest  of  the  bodj". 

Fifteenth  Day. — Face  slightly  swoUen  and  red ;  a  greenish 


EFFECTS  OP  SUBMERSION  IN  WATER — SAPONIFICATION.      451 

spot  begins  to  form  on  the  neck  and  skin^  of  the  mid-sternum. 
The  skin  of  the  hands  and  feet  is  quite  white  and  wrinkled. 
The  subcutaneous  ceUular  tissue  of  the  thorax  is  reddish  and 
the  upper  part  of  the  cortical  substance  of  the  brain  of  a  green- 
ish tint. 

At  One  Month. — The  face  is  reddish-brown,  the  eyelids 
and  lips  green  and  swollen,  and  the  neck  slightly  green.  A 
greenish  discoloration  is  also  seen  over  the  upper  and  middle 
part  of  the  sternum.  The  skin  is  wrinkled.  The  hair  and 
nails  still  remain  intact.  The  scrotum  and  penis  are  distended 
by  gas.  The  lungs  become  very  emphysematous  and  overlap 
the  heart. 

Saponification. 

When  the  bodies  were  removed  from  the  Cimetiere  des  Inno- 
cents in  Paris,  in  1786,  Fourcray  observed  that  many  of  them 
had  been  converted  into  a  substance  which  he  termed  adipo- 
CERE.  He  gave  it  this  name  because  it  resembles  both  fat 
{adeps)  and  wax  {cera).  Under  certain  circumstances  which 
will  be  considered  later,  it  is  known  to  be  a  late  jjroduct  of  the 
putrefactive  processes.  Adipocere  is  a  substance  of  a  cheese- 
like consistency,  yellow  or  yellowish-brown  in  color,  and  com- 
posed chiefly  of  a  mixture  of  the  fatty  acids.  Chevreul  has 
shown  by  analysis  that  it  is  a  true  ammoniacal  soap,  but  that 
when  formed  in  water  impregnated  with  lime  a  calcareous 
may  be  substituted  for  an  ammoniacal  base.  This  may  take 
place  either  in  a  body  exposed  to  river-water  or  buried  in  a  grave 
wet  by  water  containing  calcium  carbonate  or  sulphate.  Sapon- 
ification can  only  take  place  when  animal  fat  is  in  contact  with 
nitrogenous  matter.  Neither  fat  nor  fibrin  when  kept  separate 
will  saponify.  Skin  deprived  of  all  its  fat  will  not  be  trans- 
formed into  adipocere. 

Saponification  commences  in  the  fat  of  the  female  breast,  of 
the  cheeks  and  other  parts  of  the  body  where  large  accumula- 
tions of  fat  are  found,  such  as  around  the  kidneys  and  in  the 
omentum.  As  fat  is  distributed  extensively^  throughout  the 
body,  nearly  all  parts  may  undergo  this  transformation.  Taylor 
gives  the  following  conditions  as  favorable  to  the  change : 

1.  Bodies  of  young  persons,  because  the  fat  is  abundant  and 
chiefly  external. 


452  TIME   OF  DEATH — LOOMIS. 

2.  Bodies  of  corpulent  adults. 

3.  Exposure  of  bodies  to  the  soil  of  water-closets. 

4.  The  immersion  of  bodies  in  water,  the  change  taking 
place  more  rapidly  in  running  than  in  stagnant  water. 

5.  Humid  soil,  especially  when  bodies  are  placed  in  it  one 
upon  the  other.     In  this  case  the  lowest  of  them  is  first  changed. 

When  a  body  has  been  completely  saponified  it  may  remain 
in  this  state  for  years.  In  one  instance,  after  seventeen  years' 
burial  many  of  the  organs  could  still  be  recognized. 

The  time  required  for  saponification  to  take  place  is  some- 
times of  medico-legal  importance.  Three  years  are  usually 
necessary  for  bodies  buried  in  the  earth.  The  change  occurs 
more  rapidly  in  water.  Cases  are  recorded  where  the  body  of  a 
new-born  child  was  completely  saponified  in  six  weeks,  and 
again,  the  change  had  commenced  in  a  body  which  had  been  in 
the  water  about  four  months ;  but  these  are  unusual  cases. 

DATA    UPON  WHICH    OPINION    AS  TO    TIME  OF    DEATH  IS 

FORMED. 

The  changes  which  take  place  in  a  body  before  putrefaction 
sets  in  may  enable  a  medical  jurist  to  form  an  opinion  as  to  the 
probable  time  which  has  elapsed  since  death ;  yet  it  must  be 
remembered,  to  pronounce  the  time  which  has  elapsed  can  only 
be  done  approximately,  for  very  many  conditions  will  have  to  be 
considered,  which  will  vary  in  each  individual  case.  The  im- 
portance of  considering  the  minutest  detail  is  well  illustrated 
by  the  death  of  Prince  de  Conde,  Duke  of  Bourbon,  who  was 
found  dead  in  his  bedroom  in  the  chateau  of  St.  Cyr.  When 
discovered  at  8  o'clock  in  the  morning  the  deceased  was  found 
partly  undressed,  hanging  by  his  cravat  to  one  of  the  window 
shutters.  The  body  was  cold  and  the  lower  extremities  rigid. 
As  in  asphyxia  from  hanging  the  warmth  of  the  body  is  usually 
preserved  longer  than  under  common  circumstances,  viz. ,  from 
twelve  to  fifteen  hours,  before  which  period  rigidity  is  seldom 
complete,  the  medical  examiner  inferred  that  the  deceased  must 
have  died  very  soon  after  he  retired  to  his  bedroom  on  the  pre- 
vious night.  As  this  was  proven  to  have  been  10  p.m.,  it  fol- 
lowed that  only  ten  hours  had  elapsed — a  short  time  for  cooling 
and  rigidity  to  have  taken  place.     It  was  thus  rendered  proba- 


DATA   AS   TO   TIME   OF   DEATH.  453 

ble  that  the  hanging  took  place  soon  after  deceased  reached  his 
bedroom.  It  was  alleged  that  the  duke  had  been  murdered, 
and  that  his  body  had  been  afterward  suspended  to  create  a 
suspicion  of  suicide.  The  condition  of  the  body  was,  among 
other  things,  adverse  to  this  opinion.  From  10  to  12  o'clock 
it  was  proved  there  were  numerous  attendants  moving  about 
near  the  duke's  apartments.  They  would  have  heard  an 3^  un- 
usual noise  the  duke  must  have  made  in  resisting  his  assailant. 
But  no  noise  was  heard  in  the  room  at  that  or  any  other  time, 
and  the  presumption  of  this  being  a  homicide  was  thus  strongly 
rebutted. 

Cadaveric  rigidity,  while  often  it  will  aid  to,  is  not  a 
reliable  guide.  When  once  it  is  established  it  may  remain 
two,  three,  or  four  days,  according  to  the  season  of  the  year  and 
other  circumstances,  and  when  it  exists  there  is  no  rule  by 
which  it  can  be  determined  whether  a  body  has  been  in  this 
state  three  hours  or  three  days. 

Putrefaction,  while  appearing  on  an  average,  under  a 
mean  temperature,  in  from  three  to  six  days,  is  yet  influenced 
by  many  circumstances.  The  heat  and  moisture  of  the  sur- 
roundings, the  age,  sex,  amount  of  flesh  on  the  bod}^  mode  of 
death,  position  and  coverings  of  body,  all  must  be  considered. 

The  temperature  of  the  body  aids  us,  yet  the  retention  of 
warmth  by  the  abdominal  viscera  may  be  met  with  in  a  marked 
degree  twenty  hours  after  death ;  in  one  case,  personally  known 
to  me,  the  thermometer  registered  76°  F.  seventeen  hours  after 
death. 

The  temperature  of  the  body,  its  rigidity,  and  the  evidences 
of  putrefaction  all  furnish  data  from  which  we  can  estimate 
the  probable  time  which  has  elapsed  since  death.  It  must  be 
remembered  that  no  one  of  them  furnishes  any  positive  proof. 

Some  medical  jurists  have  attempted  to  give  a  more  definite 
character  to  these  changes  in  the  recentlj^  dead  body  by  divid- 
ing the  interval  between  the  stopping  of  the  heart's  action  and 
the  beginning  of  putrefaction  into  three  periods.  In  the  first, 
the  warmth,  pliabilitj',  and  muscular  irritability  remain.  In 
the  second,  these  conditions  are  lost  and  the  body  is  cold  and 
rigid.  In  the  third,  the  body  is  cold  and  pliant,  the  muscles 
are  relaxed,  and  the  joints  are  flexible,  the  cadaveric  rigidity 
having  entirely  ceased. 


454  TIME   OF  DEATH — LOOAIIS. 

There  can  be  no  doubt  about  the  existence  of  these  stages, 
but  when  we  come  to  define  the  precise  time  at  which  one 
begins  and  the  other  ends,  we  find  it  impossible.  For  example, 
the  first  stage  embraces  a  period  which  cannot  be  more  closely- 
defined  than  by  stating  that  the  person  may  have  been  dead 
from  a  few  minutes  to  twenty  hours — a  statement  too  vague  to 
be  upheld  by  a  counsel  who  defends  a  prisoner. 

The  changes  which  take  place  in  these  periods  and  the 
average  time  they  last  have  been  given  as  follows  by  Devergie : 

First  Period,  Few  Minutes  to  Twenty  Hours. — Character- 
ized by  warmth  of  the  body  and  general  or  partial  relaxation  of 
the  voluntary  muscles.  To  what  portion  of  this  period  the  special 
case  belongs  must  be  estimated  according  to  the  degree  of  heat 
in  the  trunk  and  extremities  and  the  degree  of' rigidity  in  the 
muscles,  the  neck  and  the  jaws  commonly  showing  this  condi- 
tion first,  the  legs  last.  Warmth  of  the  body  rarel}^  remains  as 
long  as  twenty  hours ;  in  general  it  is  sensibly  cold  in  from  ten 
to  twelve  hours.  During  this  period  the  muscles  are  suscepti- 
ble of  contraction  under  the  galvanic  current,  and  in  the  early 
stage  under  the  stimulus  of  blows. 

Second  Period,  Ten  Hours  to  Three  Days. — The  body  is 
perfectly  cold  throughout  and  rigidity  is  well  marked.  The 
muscles  no  longer  respond  to  stimuli.  The  duration  of  this  period 
seems  long,  yet  in  one  instance  the  body  will  be  found  cold  and 
rigid  nine  hours  after  death.  Again,  cooling  and  rigidity  may 
not  come  on  for  three  or  four  days. 

Third  Period,  Tliree  to  Eight  Days. — The  body  is  per- 
fectly cold.  The  limbs  and  trunk  pliant  and  free  from  cadaveric 
rigidity.  The  muscles  are  not  capable  of  contracting.  In  sum- 
mer this  period  is  much  shorter ;  often  it  will  come  on  before 
three  days. 

Putrefaction  commences  when  a  body  is  kept  under  the 
most  favorable  conditions,  in  from  six  to  twelve  days,  as  a  slight 
greenish  discoloration  of  the  abdomen  which  gradually  spreads 
throughout  the  body.  The  time  at  which  putrefaction  shows 
itself  and  the  rapidity  with  which  it  advances  is  dependent 
upon  so  many  factors,  many  of  which  it  is  impossible  often  for 
the  medical  examiner  to  ascertain,  that  too  much  reliance  must 
not  be  placed  upon  it.  Casper  estimates  the  following  to  be  the 
average  changes  generally  found  in  the  periods  of  time  given : 


DATA   AS   TO   TIME   OF   DEATH.  455 

Twenty-four  to  seventy-two  hours  after  death  a  slight 
green  color  is  visible  over  the  centre  of  the  abdomen.  The  eye- 
balls are  soft  and  yield  to  external  pressure. 

Three  to  five  days  after  death  the  green  color  of  the 
abdomen  becomes  intensified  and  general,  spreading  if  the  body 
be  exposed  to  the  air  or  buried  in  the  ground  in  the  following 
order:  genitals,  breast,  face,  neck,  upper  and  lastly  lower  ex- 
tremities. 

Eight  to  ten  days  after  death  the  discoloration  becomes 
more  intense,  the  face  and  neck  presenting  a  shade  of  reddish- 
green.  The  ramifications  of  the  superficial  veins  on  the  neck, 
breast,  and  limbs  become  ver}'  apparent.  Finally  the  patches 
congregate.  Gases  begin  to  be  developed  and  distend  the  ab- 
domen and  hollow  organs  and  to  form  under  the  skin  in  the 
subcutaneous  and  intermuscular  tissue.  The  cornea  falls  in 
and  becomes  concave.     The  sphincter  ani  relaxes. 

Fourteen  to  twenty -one  days  after  death  the  discolora- 
tion over  the  whole  body  becomes  intensely  green,  with  brown- 
ish-red or  brownish-black  patches.  The  body  is  bloated  and 
appears  greatly  increased  in  size  from  the  development  of  gases 
within  the  abdomen,  thorax,  and  scrotum,  and  also  in  the  cel- 
lular tissue  of  the  body  generally.  The  swollen  condition  of  the 
eyelids,  lips,  nose,  and  cheeks  is  usually  of  such  extent  as  to 
obliterate  the  features  and  to  destroy  the  identity  of  the  body. 
The  epidermis  peels  off  in  patches,  while  in  certain  parts,  more 
particularl}^  the  feet,  it  will  be  raised  in  blisters  filled  with  red 
or  greenish  liquid,  the  cuticle  underneath  frequently  appearing 
blanched.  The  color  of  the  iris  is  lost.  The  nails  easily  sepa- 
rate and  the  hair  becomes  loosened. 

Fourth  to  sixth  month  after  death  the  thorax  and  ab- 
domen burst  and  the  sutures  of  the  skull  give  way  from  the 
development  of  gases  within  the  head.  The  viscera  appear 
pulpy,  or  perhaps  disappear,  leaving  the  bones  exposed.  The 
bones  of  the  extremities  separate  at  the  joints.  At  an  advanced 
stage  the  soft  parts  gradually  disappear. 

In  giving  an  opinion  as  to  how  long  a  time  has  elapsed 
since  death  when  a  body  has  undergone  marked  putrefactive 
changes,  we  must  consider  carefully  not  only  the  conditions 
of  the  organs,  but  the  mode  of  death  and  the  "surroundings." 
By  these  I  mean  the  quantity  of  clothing  worn,  the  depth  of  the 


456  TIME   OF  DEATH — LOOMIS. 

grave  in  which  the  body  has  been  interred,  the  season  of  the 
year,  the  heat  and  moisture  of  the  atmosphere.  The  question 
sometimes  presents  itself  to  the  medical  examiner,  Of  two  per- 
sons found  dead,  which  died  first?  The  importance  of  this 
point  was  well  illustrated  in  the  "  Lizzie  Borden  case."  By  a 
careful  consideration  of  all  the  conditions  presented  by  each 
body  in  the  ways  I  have  indicated,  the  question  will  not  ordi- 
narily be  a  difficult  one  to  decide. 


THE 

MEDICO-LEGAL  COT^TSIDEEATIOjST 

OF 

WOUNDS, 

INCLUDING 

PUNCTITKED   AND   INCISED   WOUNDS,  AND   AYOUNDS 

MADE   BY   BLUNT   INSTRUMENTS   OTHER 

THAN   GUNSHOT   WOUNDS. 


BY 

GEORGE    WOOLSEY,  A.B.,  M.D., 

Professor  of  Anatomy  and  Clinical  Surgery  in  the  Medical  Department  of  the  Uni- 
versity of  the  City  of  New  York  ;  Surgeon  to  Bellevue  Hospital ;  Member 
Medical  Society  of  the  County  of  Neiv  York,  New  York  Academy 
of  Medicine,  New  York  Surgical  Society,  etc. ,  etc. 


AVOUXDS. 

GENERAL    CONSIDERATIONS.     THE    DIFFERENT    KINDS    OF 

WOUNDS. 

The  surgical  and  medico-legal  ideas  of  wounds  are  quite 
different,  the  latter  including  the  former  as  well  as  other  varie- 
ties of  injuries. 

Definitions. — Surgically  a  ivouncl  means  a  solution  of  con- 
tinuity and  refers  to  every  such  lesion  produced  by  external 
violence  or  developing  spontaneously.  The  medico-legal  ac- 
ceptation of  the  term  is  much  broader  and  includes  any  injur}^ 
or  lesion  caused  by  mechanical  or  chemical  means.  Vibert  * 
quotes  Fodere  as  defining  a  wound  medico-legally  as,  "  Every 
lesion  of  the  human  body  by  a  violent  cause  of  which  the  results 
are,  singly  or  combined,  concussion,  contusion,  puncture,  inci- 
sion, tear,  burn,  twist,  fracture,  luxation,  etc. ;  whether  the 
cause  is  directed  against  the  body  or  the  body  against  the 
cause. "  The  same  author  quotes  another  definition  of  a  wound 
as,  "  Every  lesion  however  slight,  resulting  in  concerning  or 
affecting  the  body  or  health  of  an  individual."  Taylor  ^  defines 
a  wound  in  a  medico-legal  sense  as  "  a  breach  of  continuity  in 
the  structures  of  the  body  whether  external  or  internal,  sud- 
denly occasioned  by  mechanical  violence."  Thus,  the  term 
wound  in  its  medico-legal  acceptation  includes  not  only  sur- 
gical wounds  but  contusions,  fractures,  burns,  concussion,  etc. 
In  France  at  least  the  voluntary  inoculation  of  syphilis  has 
been  considered  as  coming  under  the  category  of  wounds.' 

Medico-legallj^,  the  severity  of  a  wound  is  much  more  im- 
portant than  the  kind  of  wound.  Thus  we  may  consider 
wounds  according  to  their  comparative  gravity,  as  mortal, 
severe,  or  slight. 

'  "  Precis  de  Med.  Leg. , "  2d  Ed. ,  '  Arret  du  tribunal  de  Lyon,  8  et 

1890.  ISdecembre,  1859. 

-"Med.   Jurisprud. ,"  11th  Amer. 
Ed.,  1892. 


460  WOUNDS — WOOLSEY. 

A  mortal  wound  is  one  which  is  directly  fatal  to  life  in  a 
comparatively  short  time,  usually  from  hemorrhage,  shock,  or 
the  injury  of  a  vital  part.  A  wound  may  result  fatally  with- 
out being  a  mortal  wound,  as  when  a  slight  wound  causes  death 
on  account  of  some  wound  infection. 

Severe  ivounds,  or  "  wounds  causing  grievous  bodily  harm," 
as  they  have  long  been  called,  do  not  put  life  in  imminent  dan- 
ger, though  they  may  be  inconvenient  or  detrimental  to  health. 
Pollock,  C.  B.,  says  that  a  wound  causing  grievous  bodily  harm 
is  "  any  wound  requiring  treatment. " 

A  medical  opinion  or  certificate  may  be  required  as  to  the 
danger  of  a  given  wound,  and  on  this  opinion  may  depend  the 
question  of  bail  for  the  prisoner.  By  the  danger  of  a  wound  in 
such  a  case  is  usually  meant  imminent  danger,  as  any  wound 
maj^  be  remotely  dangerous  to  life. 

Slight  wounds,  as  already  stated,  may  result  fatally  under 
certain  conditions.  Under  the  French  practice  a  slight  wound 
is  one  which  does  not  incapacitate  one  from  work  for  more 
than  twenty  days.  Looked  at  in  another  way,  slight  or  severe 
wounds  may  be  classified  according  as  they  are  completely 
curable,  leaving  no  infirmity  or  disturbance  of  function,  or  not 
completely  curable.  The  latter  are  such  as  are  necessarily  fol- 
lowed by  permanent  or  temporary  infirmity. 

The  question  as  to  the  severity  of  any  given  wound  may 
sometimes  be  left  to  the  jury  to  decide  from  the  description  of 
the  wound,  or  a  medical  opinion  may  be  required. 

Although  the  intent  of  the  assailant  is  often  of  equal  or 
greater  importance  than  the  severity  or  kind  of  wound,  yet 
this  can  only  occasionally  be  inferred  from  the  surgical  aspects 
of  the  wound. 

The  classes  of  wounds  to  be  treated  in  the  following  pages 
are  incised  and  punctured  wounds  and  wounds  with  blunt  in- 
struments, some  of  the  characteristics  of  which  we  will  now 
consider. 

Incised  "wounds  are  such  as  are  produced  by  a  cutting  in« 
strument,  and  they  are  distinguished  b}^  the  following  charac- 
teristics: They  measure  more  in  length  than  in  the  other 
dimensions.  They  are  usually  straight  in  direction,  though 
not  infrequently  curved,  and  they  may  even  be  zig-zag,  espe- 
cially where  the  skin  lies  in  folds.     The  edges  of  an  incised 


INCISED    WOUNDS.  4G1 

wound  are  linear,  and  show  no  signs  of  contusion.  They  are 
either  inverted  or  everted  and  the  edges  and  sides  of  the  wound 
are  retracted.  The  eversion  of  the  skin  is  due  to  its  elasticity, 
but  in  some  regions  of  the  bodj',  e.g.,  in  the  scrotum,  etc.,  the 
skin  is  inverted  owing  to  the  contraction  of  the  muscle  fibres 
immediately  beneath.  The  gaping  of  the  wound  is  due  to  the 
retraction  of  the  divided  muscles  and  fibrous  structures.  It 
varies  according  as  the  muscles  are  cut  directly  across  or  more 
lengthwise,  and  in  proportion  to  the  distance  of  the  wound 
from  the  points  of  attachment  of  the  muscles. 

The  fibrous  tissues,  fascije,  and  aponeuroses  retract  less, 
and  so  give  a  somewhat  irregular  surface  to  a  large  wound. 

Ogston '  divides  incised  wounds  into  three  parts,  the  com- 
mencement, centre,  and  end,  of  which  the  end  often  has  two  or 
more  serrations  differing  from  the  commencement,  which  has 
but  a  single  point.  There  are  often  one  or  more  slight,  super- 
ficial, tentative  incisions  situated  almost  always,  though  not  in- 
variably, near  the  commencement.^  The  deepest  part  of  the 
wound  is  more  often  near  the  commencement.  If  there  are 
angular  flaps  on  the  edges  their  free  angles  point  to  the  com- 
mencement of  the  wound. 

Coagula  and  clots  of  blood  are  to  be  found  in  the  wound, 
more  or  less  filling  it  up  if  it  has  not  been  interfered  with.  On 
examination  the  ends  of  the  divided  vessels  are  found  plugged 
with  clots  which  may  protrude  somewhat  from  their  openings. 

If  the  wound  is  seen  very  shortly  after  its  infliction,  hemor- 
rhage is  in  progress,  and  the  divided  arteries  show  their  posi- 
tion by  their  individual,  intermittent  jets  of  blood.  The  sever- 
ity of  incised  wounds  depends  upon  the  amount  of  hemorrhage, 
which  is  greater  the  deeper  and  larger  the  wound,  and  the 
more  vascular  the  tissues  in  which  it  occurs,  especially  if  large 
and  important  vessels  are  concerned.  In  the  latter  case  an 
incised  wound  may  be  very  rapidly  fatal. 

Incised  wounds  present  the  least  favorable  conditions  for  the 
spontaneous  arrest  of  hemorrhage  of  any  form  of  wounds.  The 
edges  of  an  incised  wound  may  be  quite  rough  and  even  dentated 
or  lacerated  if  the  edge  of  the  weapon  be  rough  and  irregular. 

The  kind  and  condition  of  a  weapon  which  has  produced  a 

'"Lectures  on  Med.  Jurisprud. , "  '^ See  Figs.  10  and  11. 

1878,  pp.  422,  423. 


4G2  WOUNDS — WOOLSEY. 

given  incised  wound  may  often  be  learned  by  an  examination 
of  the  characteristics  of  the  wound. 

Weapons  cutting  by  their  weight  as  well  as  by  the  sharp- 
ness of  their  edges,  such  as  axes,  etc.,  may  cause  a  certain 
amount  of  contusion  about  a  wound ;  they  crush  the  soft  parts 
to  a  certain  extent,  and  the  bones  may  be  indented  or  even 
fractured. 

Wounds  caused  by  fragments  of  bottles,  pieces  of  china, 
earthenware,  or  glass,  though  strictly  speaking  incised  wounds, 
are  often  curved,  angular,  and  irregular,  and  their  edges  jagged 
and  contused. 

Wounds  caused  by  scissors  may  sometimes  be  of  the  nature 
of  incised  wounds.  When  they  present  a  double  wound  of 
triangular  shape,  with  the  apex  of  the  triangle  blunt,  they  are 
more  of  the  nature  of  punctured  wounds.  In  general  a  "tail" 
or  long  angle  in  the  skin  at  one  end  of  an  incised  wound  indi- 
cates the  end  of  the  wound  last  inflicted,  and  some  light  may 
thus  be  thrown  upon  the  inflicter  of  the  wound. 

Incised  wounds  present  very  favorable  conditions  for  healing 
by  primary  union,  but  often  fail  in  this  and  heal  by  secondary 
union.  When  an  incised  wound  fails  to  unite  by  primary 
union,  bleeding  continues  for  several  hours  or  even  as  long  as  a 
da}^  the  blood  being  mixed  more  or  less  with  a  serous  dis- 
charge. The  latter  continues  until  the  third  day  or  so.  By  the 
fourth  or  fifth  day  the  surface  has  begun  to  granulate,  and  there 
may  be  a  more  or  less  profuse  purulent  discharge  from  the  sur- 
face. The  granulating  surfaces  do  not  necessarily  discharge 
pus,  however.  For  some  days,  therefore,  after  the  infliction  of 
an  incised  wound,  or  until  the  surface  is  covered  with  granu- 
lations, the  characteristics  of  the  wound  permit  of  a  diagnosis 
as  to  the  nature  of  the  wound. 

The  diagnosis  of  an  incised  wound  is  generally  without 
difficulty.  Some  wounds  by  blunt  instruments,  however,  in 
certain  regions  of  the  body,  resemble  incised  wounds  very 
closely.  Such  instances  are  found  where  a  firm,  thin  layer  of 
skin  and  subjacent  tissue  lies  directly  over  a  bony  surface  or  a 
sharp  ridge  of  bone.  These  are  seen  most  often  in  the  scalp  or 
in  wounds  of  the  eyebrow  where  the  sharp  supra-orbital  ridge 
cuts  through  the  skin  from  beneath.  The  diagnosis  of  an  in- 
cised wound  can  often  be  made  with  great  probability  from  the 


PUNCTURED    WOUNDS,  STABS,  ETC.  463 

cicatrix.  This  is  especially  the  case  if  the  wound  has  healed 
by  primary  union  and  the  cicatrix  is  linear. 

The  prognosis  in  incised  wounds  is  good  as  to  life  unless  a 
large  vessel  has  been  divided  or  unless  an  important  viscus 
has  been  penetrated.  The  prognosis  as  to  function  varies  with 
the  position  and  extent  of  the  wound,  and  the  circumstance  of 
the  healing  of  the  wound. 

Punctured  Wounds,  Stabs,  etc. — These  are  character- 
ized by  narrowness  as  compared  to  depth,  though  the  depth  is 
not  necessarily  great.  They  are  more  varied  in  character  than 
incised  wounds  owing  to  the  great  variety  of  form  of  the  weapons 
by  which  they  may  be  made.  From  the  form,  etc. ,  of  a  partic- 
ular wound  we  may  often  infer  the  variety  of  weapon  by  which 
it  was  produced.  According  to  the  weapon  used,  punctured 
wounds  have  been  divided  into  several  classes,  of  which  M. 
Tourdes  distinguishes  four:  1st.  Punctured  wounds  by  cylin- 
drical or  conical  instriiments  like  a  needle.  If  the  instru- 
ment be  very  fine  like  a  fine  needle,  it  penetrates  by  separating 
the  anatomical  elements  of  the  skin,  etc.,  without  leaving  a 
bloody  tract.  Such  wounds  are  generally  inoffensive,  even  when 
penetrating,  if  the  needle  is  aseptic,  and  they  are  difficult  to  ap- 
preciate. On  the  cadaver  it  is  almost  impossible  to  find  the  tract 
of  such  a  wound.  If  the  instrument  be  a  little  larger  it  leaves 
a  bloody  tract,  but  it  is  difficult  to  follow  this  in  soft  tissues, 
more  easy  in  more  resistant  structures,  such  as  tendon,  aponeu- 
rosis, cartilage,  or  serous  membrane. 

If  the  instrument  be  of  any  size  this  variety  of  punctured 
wounds  presents  a  form  quite  different  from  that  of  the  weapon. 
Instead  of  a  round  wound  it  is  generally  a  longitudinal  wound 
with  two  very  acute  angles  and  two  elongated  borders  of  equal 
length,  showing  but  little  retraction.  This  is  the  shape  of  the 
wound  even  when  the  instrument  producing  it  is  so  large  that 
the  resulting  wound  resembles  that  made  by  a  knife  (see  Fig. 
2).  The  direction  of  the  long  axis  of  these  wounds  varies  in 
different  parts  of  the  body  and  is  uniform  in  the  same  part. 
Their  shape  and  direction  are  explained  by  the  tension  of  the 
skin  or  still  more  clearly  by  the  direction  of  the  fibres  of  the 
skin,  just  as  with  the  same  round  instrument  in  a  piece  cf  wood 
a  longitudinal  opening  or  split  would  be  made  parallel  to  the  grain 
(see  Fig.  1).     In  some  regions,  as  near  the  vertebrae,  the  fibres 


464 


WOUNDS — WOOLSEY. 


may  run  in  dififerent  directions,  and  the  resulting  wound  is  stel- 
late or  triangular  in  shape  as  if  a  many-sided  instrument  had 
caused  it.  As  the  direction  of  the  fibres  of  the  various  tissue 
layers,  such  as  aponeuroses,  serous  and  mucous  membranes,  etc.,. 


Fig.  1.— Direction  of  the  Long  Axis  of  Wounds  of  the  Back  caused  by  Conical  Instruments. 

(After  Longer.) 

may  be  different,  a  deep  wound  involving  several  such  layers 
would  have  a  different  direction  for  each  layer.  In  illustration  of 
this,  examine  the  figure  of  a  wound  through  the  wall  of  the 
stomach  (see  Fig.  3) . 

The  wounds  above  described  when  large  are  smaller  than 


PUNCTURED    WOUNDS   BY   INSTRUMENTS. 


4G5 


the  weapon,  as  the  splitting  of  the  skin  has  certain  limits  and 
also  owing  to  the  elasticity  of  the  skin,  which  is  put  on  the 
stretch  by  the  weapon  and  relaxed  on  its  withdrawal.      When 


Fig.  2.— Slit-like  Wound  caused  by  a  Pointed 
Conical  Instrument  2.5  cm.  in  Diameter.  Nat- 
ural size. 


Fig.  3.— Wounds  of  Stomach  Wall'by 
a  Conical  Instrument,  showinf?  the  Dif- 
ferent Direction  of  the  Long  Axis  of  the 
Wounds  in  Different  Layers. 


such  wounds  are  small  they  are  larger  as  a  rule  than  the  in- 
strument causing  them. 

2d.  Punctured  wounds  by  instruments  both  sharp-pointed 
and  cutting,  like  a  knife  or  dagger.  If  these  wounds  are  per- 
pendicular to  the  surface,  they  have 
more  or  less  the  form  of  the  weapon 
used.  The  angles  may  show  whether 
the  knife,  etc.,  had  one  or  two  cut- 
ting edges,  but  even  though  the 
back  of  the  knife  is  broad  the  wound 
may  resemble  one  caused  by  a 
double-edged  weapon.  Thus  stab- 
wounds  from  a  common  pocket- 
knife  show  only  exceptionally  a 
wedge-shape,  but  regularly  a  slit, 
the  edges  of  which  are  slightly 
curved  to  one  another  and  end  in 
two  acute  angles.  The  reason  of 
this  lies  in  the  fact  that  the  wound 
is  only  caused  by  the  cutting  edge  of 
the  knife,  so  that  we  cannot  tell  as  a 
rule  which  angle  was  occupied  by  the  back  of  such  a  knife  (Figs. 
4  and  5) .  The  depth  of  these  wounds  may  equal  the  length  of 
the  weapon  or  be  almost  any  degree  less,  but  the  depth  may 
30 


Fig.  4.— stab-Wound  of  the  Skin 
with  a  Knife  a  Few  Minutes  before 
Death. 


466 


WOUNDS — WOOLSEY. 


Fig.  5. 


-Nine  Suicidal  Stab- Wounds  in  the  Region  of  the  Heart 
made  by  a  Knife  used  for  Cutting  Rubber. 


even  be  greater  than  the  length  of  the  weapon  by  reason  of  a 
depression  of  the  parts  at  the  time  of  the  blow.  The  wound 
is  often  shorter  and  broader  than  the  weapon  causing  it, 
__^^__^^^  though   more  often 

■•''^      -  -- .  •  :-S:^-ix^;^£L-.'^  ^^  ^g  larger  than  the 

weapon  from  the  ob- 
1  i  q  u  i  t  y  of  the 
wound  and  the 
movement  of  the 
weapon  on  being 
withdrawn.  The 
wound  is  smaller 
than  the  instrument 
where  the  parts  are 
on  the  stretch  at  the 
time  the  wound  is 
inflicted. 

This  variet}'  of 
punctured  wounds 
may  resemble  the 
former  class  in  the  direction  of  its  long  axis,  if  the  cutting 
edge  of  the  instrument  is  blunt.  The  regularity  and  smoothness 
of  the  edges  distinguish  them  from  certain  contused  wounds. 

3d.  Wounds  tnade  by  instru- 
ments with  ridges  or  edges,  files, 
foils,  etc.  If  the  edges  are  cutting 
the  wound  presents  more  or  less  the 
shape  of  the  weapon  (Fig.  6).  But 
this  is  not  alwaj^s  so,  probably  from 
the  instrument  puncturing  oblique- 
ly or  from  the  tissues  being  unequal- 
ly stretched  (Fig.7) .  If  the  edges 
are  not  cutting  the  wound  resem- 
bles those  of  the  first  class,  though 
the  edge  often  presents  little  tears, 
and  the  wound  may  thus  be  more 
or  less  elliptical  with  two  un- 
equal angles.  The  wound  of  entrance  and  exit  may  be  different. 
4th.  Irregular  perforating  instruments,  the  wounds  from 
which  resemble  contused  wounds. 


Fig.  6.— stab- Wounds  caused  by  a 
Three-Sided  Sharp-Edged  Pointed  In- 
strument. 


CONTUSIONS    AND    CONTUSED    WOUNDS. 


467 


Contusions  and  Contused  Wounds. — A  contusion  is  a 
wound  of  living  tissues  by  a  blow  of  a  hard  body,  not  sharp- 
edged  or  pointed,  or  by  a  fall,  crushing,  or  compression,  and 
without  solution  of  continuity  of  the  skin.  A  contusion  usually 
involves  a  moderately  large  surface  in  comparison  to  the  two 
other  classes  of  wounds.  Contusions  are  of  all  degrees  of  sever- 
ity. If  the  blow  or  injury  is  slight,  there  is  only  slight  redness 
and  swelling  of  the  skin  with  pain,  disappearing  in  a  few  hours, 
and  leaving  no  traces.  If  the  blow  be  harder  it  produces  more 
or  less  crushing  of  the 
tissues,  accompanied 
by  ecchymosis  with  or 
without  a  wound  or  ex- 
coriations of  the  skin, 
etc.  The  contusion 
may  have  the  shape  of 
the  contusing  body, 
such  as  a  whip,  the 
fingers,  etc. 

Ecchymosis. — 
This  is  characteristic, 
as  a  rule,  of  contused 
wounds.  It  consists  in 
the  infiltration  of  blood 
into  the  tissues,  espe- 
cially the  cellular  tis- 
sues. The  source  of  the 
blood  is  from  the  rupture  of  blood-vessels,  and  the  size  of  the 
ecchymosis  varies  partly  with  the  number  and  size  of  the  blood- 
vessels, or  with  the  vascularity  of  the  part.  The  size  of  the  ec- 
chymosis also  varies  with  the  looseness  of  the  tissues  into  which 
it  is  infiltrated.  This  looseness  of  the  tissues  may  be  natural  as 
in  the  scrotum  and  eyelids,  or  it  may  be  due  to  the  attrition  of  the 
tissues  caused  by  the  blow.  An  ecchymosis  is  larger  when  the 
contused  parts  cover  a  bony  or  resisting  surface,  and  there  may 
be  no  ecchymosis  whatever,  even  from  a  severe  blow,  where  the 
underlying  parts  are  soft  and  yielding,  as  is  the  case  with  the 
abdominal  parietes.  Here  we  may  have  rupture  of  the  viscera 
without  any  signs  of  ecchymosis  superficialh'.  An  ecchymosis 
may  be  infiltrative  or  it  may  mostly  occupy  a  cavity  usually 


Fig.  7.— Stab-Wounds  caused  by  an  Eight-Sided 
Sharp-Edged  Instrument.  Some  show  a  transition 
stage  to  wounds  made  by  a  conical  instrument. 


468  WOUNDS — WOOLSEY. 

formed  by  a  traumatic  separation  of  the  tissues ;  this  is  espe- 
cially the  case  in  the  scalp  and  extremities  when  the  injury  is 
severe.  These  tumors,  which  are  called  liematomata,  may  be 
rapidly  absorbed  or  they  may  remain  a  long  time  and  occasion- 
ally suppurate.  Sometimes  the  anatomical  conditions,  espe- 
cially of  the  connective-tissue  spaces,  allow  the  extension  or 
migration  of  the  ecchymosis  under  the  action  of  gravity,  even 
to  a  considerable  distance.  When  it  meets  an  obstacle  it  accu- 
mulates above  it,  as  in  the  inguinal  region  for  abdominal  ec- 
chymosis and  at  the  knee  for  those  of  the  thigh.  The  course 
along  which  the  ecchymosis  travels  is  indicated  externally  by  a 
yellowish  stain,  soon  disappearing,  so  that  soon  no  sign  persists 
at  the  site  of  injury,  but  only  below  where  the  blood  is  arrested. 

An  ecchymosis  becomes  visible  at  varying  times  after  the 
injury  according  to  the  depth  of  the  ecchymosis  and  the  thinness 
of  the  skin,  for  the  ecchymosis  is  mostly  beneath,  not  in  the  skin. 
If  the  ecchymosis  is  superficial  it  shows  in  one  or  two  hours  or 
even  in  less  time  where  the  skin  is  very  thin,  as  in  the  eyelids 
and  scrotum.  In  such  cases  it  increases  for  thirtj'"  or  forty 
hours  and  disappears  in  a  week,  but  may  last  longer,  i.e.,  as 
long  as  fifteen  to  twenty-five  days. 

An  ecchymosis  may  not  show  at  the  point  struck,  at  least 
not  until  several  days  have  elapsed,  or  it  may  only  show  on  the 
under  surface  of  the  subcutaneous  fat  until  it  has  imbibed  its 
way,  as  it  were,  to  the  surface.  This  may  explain  the  discrep- 
ancy in  the  description  of  an  injury  examined  by  two  medical 
experts  at  different  times. 

If  an  ecchymosis  is  extensive  and  deep,  especially  if  it  occu- 
pies a  cavity,  there  may  be  nothing  to  see  in  the  skin  for  four 
or  five  days,  and  then  often  only  a  yellowish  discoloration  in- 
stead of  a  dark  blue  color.  In  such  cases,  too,  the  appearance 
in  the  skin  may  be  more  or  less  remote  from  the  injury,  having 
followed  the  course  of  the  least  anatomical  resistance.  Between 
these  two  extremes,  an  ecchymosis  may  become  visible  at 
almost  any  time.  Rarely  an  ecchymosis  occurs  only  deeply  be- 
tween muscles  (pectorals,  etc.)  and  not  superficially  at  all. 

The  extravasation  of  blood  which  forms  an  ecchymosis  has 
sometimes  been  given  different  names,  according  to  its  extent 
or  position,  for  instance,  parenchymatous  or  interstitial  hemor- 
rhages or  apoplexies,  suffusions,  ecchymoses,  petechise  or  vibices. 


ECCHYMOSIS.  469 

All  such  may,  however,  be  called  ecchymoses  or  hematomata. 
When  blood  is  effused  into  the  serous  cavities  of  the  body, 
special  names  are  sometimes  applied  according  to  the  position, 
such  as  hemothorax,  hematocele,  etc. 

The  color  of  an  ecchymosis  is  at  first  a  blue-black,  brown,  or 
livid  red.  This  color  changes  first  on  the  edges,  later  in  the 
darker  centre,  and  becomes  in  time  violet,  greenish,  yellow, 
and  then  fades  entirely.  This  change  in  color  is  owing  to  a 
gradual  decomposition  of  the  haemoglobin  of  the  blood.  We 
can  tell  the  age  of  an  ecchymosis  from  its  coloration  only 
within  uather  wide  limits,  for  the  rapidity  of  change  of  color 
varies  widely  according  to  a  large  number  of  circumstances, 
especially  according  to  whether  the  ecchymosis  is  superficial  or 
deep.  We  can  only  say  that  the  first  change,  i.e.,  that  to  vio- 
let, in  a  superficial  ecchymosis,  occurs  in  two  or  three  days. 

As  an  exception  to  the  above  color  change,  we  may  mention 
sub-conjunctival  ecchymosis,  which  always  remains  a  bright 
red,  as  the  conjunctiva  is  so  thin  and  superficial  that  the  color- 
ing matter  of  the  blood  is  constantly  oxidized. 

The  form  of  an  ecchymosis  often  reproduces  well  enough 
that  of  the  instrument,  except  if  the  latter  be  large  it  cannot  all 
be  equally  applied  to  the  surface,  and  its  form  is  not  distinctly 
shown  by  that  of  the  ecchymosis.  After  its  first  appearance 
an  ecchymosis  spreads  radially,  the  edges  becoming  less  clear. 
This  change  occurs  more  rapidly  the  looser  the  surrounding 
tissues,  and  at  the  end  of  a  few  days  the  first  form  of  an  ecchy- 
mosis may  be  changed,  so  that  an  examination  to  determine 
the  nature  of  the  weapon  should  be  made  as  early  as  possible. 

Ecchymoses  are  more  easily  produced  in  the  young,  the 
aged,  and  in  females,  also  in  the  case  of  such  general  diseases 
as  scurvy,  purpura,  hemophilia,  etc.  In  fact,  in  the  last  three 
classes  they  may  occur  spontaneously.  This  fact  should  never 
be  lost  sight  of,  as  the  attempt  may  be  made  to  explain  a  trau- 
matic ecchymosis  in  this  way.  The  diagnosis  between  the 
traumatic  variety  and  such  cases  of  spontaneous  ecchymoses  is, 
in  general,  eas}^  for  in  the  latter  case  their  number,  form,  size, 
and  occurrence  on  parts  little  exposed  to  injury  and  on  the 
mucous  membranes,  as  well  as  the  general  symptoms  of  the 
disease,  leave  little  or  no  room  for  doubt. 

From  an  oblique  or  glancing  blow  a  considerable  area  of 


470 


WOUNDS — WOOLSEY 


skin  may  be  stripped  up  from  its  deep  attachments  forming  a 
cavity  which  may  be  filled  by  a  clear  serous  fluid  alone,  or  with 
some  admixture  of  blood.  These  cases  have  been  studied  espe- 
cially by  Morel  Lavallee  and  Leser,  and  the  fluid  has  been 
thought  to  be  lymphatic  in  origin,  hence  the  name  "  lymphor- 
rliagia.''^  Carriage  accidents,  especially  where  the  wheels  do 
not  pass  directly  but  obliquely  across  or  merely  graze  the  body, 
are  especially  liable  to  show  this  form  of  extravasation,  which 
is  thought  to  be  more  common  than  is  generally  supposed,  being 
often  obscured  by  a  small  qviantity  of  blood. 

Contused  Wounds.— If  with  the  contusion  we  have  a 
solution  of  continuity  of  the  skin,  then  we  have  a  contused 
wound.     This  may  sometimes  resemble  an  incised  wound  if 


Fig.  8. — Linear  Wound  with  Nearly  Clean-Cut  Edges,  with  Strands  of  Tissue  bridging  across 
at  the  Bottom  and  caused  by  a  Fall  on  the  Head  on  a  Smooth  Surface. 


the  weapon  has  marked  angles  or  edges,  as  a  hammer,  or,  as 
we  have  already  seen,  in  wounds  of  the  scalp  or  eyebrow  (Fig. 
8).  Careful  examination,  however,  by  a  small  lens  if  neces- 
sary, is  sufficient  to  distinguish  them  if  they  are  fresh. 
If  they  are  four  or  five  days  old  and  have  begun  to  granulate, 
it  may  be  impossible  to  distinguish  them.  Contused  wounds 
present  on  examination  small  tears  on  the  edges  which  are 
widely  separated  and  more  or  less  extensively  ecchymosed. 
Contused  wounds  are  often  irregular,  and  have  thickened  or 
swollen  and  ragged  borders.  They  may,  like  simple  con- 
tusions, show  b}'-  their  shape  the  form  of  the  instrument 
which  caused  them.  In  contused  wounds,  unless  they  be  per- 
fectly aseptic,  we  usually  find  sloughing  of  the  contused, 
necrotic  tissues.     This  leaves  a  cavity  to  be  filled  up  by  granu- 


LACERATED   WOUNDS.  471 

lation  like  wounds  with  loss  of  substance.  They  therefore 
often  present  large  cicatrices  which  may  be  mistaken  for  those 
of  ulcers.  In  contused  wounds  the  bone  may  sometimes  show 
the  impression  of  the  instrument  causing  the  wound. 

A  variety  of  contused  wounds  is  that  where  the  wound  of 
the  skin  consists  merely  of  an  erosion  or  excoriation  with  an 
ecchymosis  beneath.  The  wound  may  reproduce  the  shape  of 
the  weapon,  i.e.,  finger-nails,  etc.  After  death  the  skin  be- 
comes brownish-yellow,  hard,  and  dry,  and  then  they  are  called 
by  the  French  "plaques  parcheminees."  They  are  distin- 
guished, as  a  rule,  from  those  produced  after  death,  by  the 
ecchymosis  beneath. 

Lacerated  wounds  resemble  contused  wounds  very 
closely,  but  are  not  ecchymosed  to  any  considerable  extent. 
The  solution  of  continuity  is  sometimes  very  extensive  and 
irregular,  and  may  present  several  flaps.  The  bone  or  bones 
are  often  fractured  at  the  same  time.  Thej  seldom  bleed  much. 
The  course  of  repair  resembles  that  of  contused  wounds  as  a 
rule.  The  prognosis  is  variable,  for  there  may  be  slow  and 
extensive  cicatrization  and  impairment  of  function,  etc.  These 
wounds  usually  result  from  machinery  accidents  and  accidental 
tears,  etc.  They  are  therefore  seldom  the  occasion  of  criminal 
proceedings  but  more  often  of  a  civil  suit,  and  thus  require 
medical  examination. 

The  injury  which  causes  a  contusion  or  contused  wound 
may  not  infrequently  produce  effects  far  more  serious  and  more 
or  less  remote  from  the  contusion.  Some  of  these  effects  it 
may  be  well  to  particularize.  Blows  on  the  abdomen  are  some- 
times quicklj^  followed  by  death  without  visible  lesion  to  ac- 
count for  it.  That  authentic  examples  of  this  exist  has  been 
denied  by  Lutaud,  except  for  cases  of  rapid  death  following 
contusions  of  the  abdomen  which  had  caused  extensive  rupture 
of  the  viscera  and  abundant  hemorrhage.  But  Vibert  gives 
two  cases  from  his  own  experience,  which  are  as  follows : 

A  young  man,  twenty  years  old,  received  a  kick  in  the 
stomach  at  a  public  ball.  Numerous  witnesses  of  the  scene 
testified  that  he  only  received  this  one  blow.  The  man  collapsed 
immediately  and  died  in  a  few  minutes.  On  autopsy  nothing 
was  found  but  two  small  ecchymotic  spots  in  the  peritoneum 
covering  the  intestine,  the  largest  not  the  size  of  a  bean. 


472  WOUNDS — WOOI.SEY. 

In  the  second  case,  the  injury  was  also  a  kick  in  the  stom- 
ach and  the  man  died  almost  immediately.  Absolutely  no 
lesion  was  found  on  autopsy.     Both  were  in  full  digestion. 

Konig'  says:  "A  number  of  severe  contusions  of  the 
belly  run  a  rapidly  fatal  course  without  the  autopsy  showing 
any  definite  anatomical  lesion  of  the  viscera."  He  also  adds 
that  the  less  severe  cases  at  first  often  show  .very  profound 
shock,  which  is  out  of  proportion  to  the  force  of  the  injury. 
The  cause  of  death  has  been  explained,  like  that  of  sudden 
death  from  a  blow  on  the  larynx,  by  the  theory  of  inhibition. 
These  cases  are  often  illustrated  experimentally  on  fro^s,  where 
the  same  result  is  obtained  under  similar  conditions.  Such 
cases  are  the  more  remarkable  from  the  fact  that  the  fatal  blow 
maj'  cause  no  ecchymosis  or  other  mark  of  injury  to  appear  on 
the  abdominal  walls. 

Blows  on  the  head  may  produce  a  variety  of  results  besides 
that  of  the  contusion  itself.  In  fact,  death  itself  may  result 
though  the  marks  of  contusion  are  very  slight  or  even  imper- 
ceptible. Intracranial  hemorrhage,  laceration  with  ecchymo- 
sis of  the  brain,  on  the  same  or  opposite  side  to  the  injury,  and 
concussion  of  the  brain  may  result.  Of  these  only  concussion 
will  be  considered  now. 

Concussion  has  been  defined  as  a  shock  communicated  to 
an  organ  by  a  blow  or  fall  on  another  part  of  the  body,  which 
may  or  may  not  be  remote,  and  without  producing  a  material  or 
appreciable  lesion.  According  to  Lutaud,'  English  pathologists 
understand  by  it  a  temporary  or  permanent  nervous  exhaustion 
resulting  from  a  sudden  or  excessive  expense  of  nervous  energy. 
Its  effect  is  observed  in  the  function  of  an  organ  and  especially 
in  the  brain.  Concussion  of  the  brain  causes  stupidity,  loss  of 
consciousness,  amnesia,  coma.  The  intracranial  lesion  most 
often  associated  with  concussion  is  ecchymosis  and  laceration 
on  the  surface  of  the  brain,  but  there  may  be  no  lesion  visible 
even  if  the  case  is  a  fatal  one.  Fatal  concussion  has  been  ob- 
served where  the  marks  of  external  violence  were  very  slight  or 
even  failed  entirely,  as  illustrated  by  the  two  following  cases 
cited  by  Vibert :  ^ 

Vibert  made  an  autopsy  on  a  man  who  had  been  struck  by  a 

'  "Lehrbuch  der  Speciellen  Chi-       «" Manuel  de  Leg. , "  5th  Ed.,  1892. 
rurgie. "  ^ "  Pr^cis  de  Med.  Leg. , "  2d  Ed. ,  1890. 


CONCUSSION.  473 

pitchfork,  one  of  the  teeth  of  which  struck  behind  the  ear,  the 
other  two  in  the  face,  only  producing  slight  skin  wounds. 
The  man  immediately  lost  consciousness  and  died  in  two  days 
in  coma.  No  lesion  whatever  was  found  within  the  skull,  and 
only  three  slight  ones  externally. 

He  observed  another  case  where  the  man  fell  three  or  four 
metres  into  an  excavation,  landing  on  his  feet,  and  died  in  a 
short  time.  On  autopsy  only  slight  erosions  and  no  intra- 
cranial or  extracranial  lesions  were  found. 

This  case  belongs  to  a  rare  class  where  the  blow  is  trans- 
mitted through  the  spinal  column  without  sign  of  injury  exter- 
nally or  internally  to  the  head. 

The  following  case  cited  by  Vibert  is  even  more  remarkable 
in  the  production  of  the  severe  though  not  fatal  concussion : 
An  officer  was  riding  at  full  speed  on  horseback,  when  his  horse 
suddenly  stopped  short.  By  great  exertion  the  officer  clung  to 
the  horse,  but  immediately  lost  consciousness.  His  fall  from 
the  horse  was  broken  by  those  about  him,  and  the  concussion 
he  received  was  not  due  to  the  fall,  but  to  the  shock  of  stopping 
suddenly  when  his  momentum  was  great. 

As  a  rule,  however,  the  diagnosis  of  concussion,  especially 
if  it  is  severe  enough  to  be  fatal,  is  easily  made  by  the  marks 
of  external  violence  with  or  without  intracranial  lesions.  The 
effects  of  concussion  may  be  transient  and  leave  no  trace,  but, 
on  the  other  hand,  they  maj^  be  prolonged  and  severe,  i.e., 
paralysis,  aphasia,  loss  of  memory,  imbecility,  etc.  The  medi- 
cal examiner  should  be  on  his  guard  against  simulation  in 
respect  to  these  prolonged  effects  of  concussions.  One  of  the 
most  frequent  consequences  of  concussion  is  temporary  amnesia, 
which  ordinarily  succeeds  immediately  after  the  injury,  but 
sometimes  develops  more  slowly.  The  following  curious  case  is 
quoted  from  Lutaud  as  cited  by  Brouardel : 

A  woman  in  getting  out  of  a  train  at  Versailles,  where  she 
had  gone  to  attend  the  funeral  of  a  relative,  was  struck  by  the 
door  of  the  compartment.  She  fell,  but  did  not  lose  conscious- 
ness, and  picked  herself  up,  but  forgot  what  she  had  come  for. 

Another  result  of  an  injurj^  which  has  caused  a  contusion 
or  contused  wound  may  bo  a  fracture  or  dislocation.  Frac- 
tures and  dislocations  of  special  parts  will  be  referred  to  later, 
in  considering  injuries  of  the  several  regions  of  the  body,  but 


474  WOUNDS — WOOLSEY. 

it  seems  appropriate  here  to  refer  to  some  of  those  general  con- 
siderations relating  to  these  injuries  which  may  especially 
demand  the  attention  of  the  medical  expert. 

Fractures  may  be  produced  by  blows  or  falls,  or  from  mus- 
cular action.  The  medical  witness  may  be  questioned  as  to  the 
cause  of  the  fracture  or,  if  it  was  produced  by  a  blow,  whether 
a  weapon  was  used  or  not,  as  the  defence  is  likely  to  assert 
that  it  was  caused  by  an  accidental  fall.  The  nature  of  the 
associated  wounds  and  contusions,  if  any  exist,  may,  as  we 
have  seen,  indicate  the  weapon  used.  If  anything  exists  to 
indicate  that  a  fall  which  caused  the  fracture  was  not  acci- 
dental, this  should  be  noted,  as  the  assailant  is  responsible  for 
the  effects  of  the  fall. 

A  number  of  conditions  influence  the  ease  with  which  a 
fracture  is  produced  and  account  for  a  fracture  being  due  to  a 
slight  injur}',  and  so  are  mitigatorj"  circumstances  in  the  case. 

Fractures  are  more  easily  produced  in  the  old  and  young, 
especialh'  the  former,  than  in  the  adult  from  the  same  force. 
This  is  due  tobrittleness  of  the  bones  in  the  old  and  their  small 
size  in  the  young.  Certain  diseases  like  syphilis,  arthritis, 
scurvy,  carcinoma,  and  rickets  make  the  bones  more  frangible, 
and  there  is  a  peculiar  brittle  condition  of  the  bones  known  as 
fragilitas  ossium,  more  or  less  hereditary,  in  which  the  bones 
become  fractured  from  very  slight  violence.  Mercer  is  quoted 
by  Taylor  as  stating,  but  on  how  good  authorit}'  it  does  not  ap- 
pear, that  in  general  paralysis  of  the  insane  the  bones  are 
particularly  liable  to  fracture.  Certain  it  is  that  not  uncom- 
monly insane  patients  are  found  dead  with  single  or  inultiple 
fractures,  but  the  attendants  are  generally  convicted. 

In  some  parts,  like  the  orbital  plate  of  the  frontal  bone,  the 
bone  is  very  thin  and  brittle,  but  brittleness  from  any  cause 
only  mitigates,  it  does  not  excuse. 

Taj'lor '  reports  a  case  in  point  where  it  was  proved  that  the 
bones  of  the  skull  were  thin  and  brittle,  and  the  fractured  skull 
proved  fatal  from  inflammation  of  the  brain.  The  punishment 
was  mitigated  owing  to  the  circumstance  of  the  brittleness  of 
the  bones. 

Spontaneous  fractures  may  occur  from  only  a  moderate 
degree  of  muscular  action,  and  even  where  there  is  no  disease 

'Taylor:  "  Medical  Jurisprudence, "  11th  American  Edition  (1892). 


SPONTANEOUS  FRACTURES.  475 

of  the  bones,  but  the  above-mentioned  condition  of  fragilitas 
ossium,  rendering  the  bones  more  brittle,  aids  in  the  production 
of  such  fractures.  The  olecranon,  patella,  and  os  calcis  are  par- 
ticularly liable  to  such  fractures,  but  the  long  bones  of  the  ribs 
and  extremities  are  sometimes  so  fractured,  as  instanced  in  the 
following  cases  cited  by  Taylor : ' 

The  humerus  of  a  healthy  man  has  been  broken  by  muscular 
exertion  simply  by  throwing  a  cricket  ball."  In  1858  a  gentle- 
man forty  years  old,  during  the  act  of  bowling  at  cricket, 
heard  a  distinct  crack  like  the  breaking  of  a  piece  of  wood. 
He  fell  immediately  to  the  ground,  and  it  was  found  that  his 
femur  was  fractured. 

Again,  in  184C,  a  healthy  man,  set.  33,  was  brought  to 
Gray's  Hospital  with  the  following  history:  He  was  in  the  act 
of  crossing  one  leg  over  the  other  to  look  at  the  sole  of  his  foot, 
when  something  was  heard  to  give  way;  his  right  leg  hung 
down  and  he  was  found  to  have  received  a  transverse  fracture 
of  the  femur  at  the  junction  of  the  middle  and  lower  thirds. 

The  writer  had  a  case  in  Bellevue  Hospital  during  the  past 
winter  (1892-93)  of  a  man  who  stated  that  he  had  been  well  and 
active  until  some  weeks  previously,  when,  from  muscular  force 
alone,  he  sustained  a  fracture  of  the  neck  of  the  femur.  Some- 
thing abnormal  in  the  bone  may  be  present  in  such  cases. 

In  cases  of  spontaneous  fractures  there  are  no  marks  of  ex- 
ternal violence  which,  if  present,  would  remove  the  idea  of 
spontaneity. 

Fractures  of  the  extremities  are  not  dangerousper  se,  unless 
they  are  compound  or  occur  in  old,  debilitated,  or  diseased  per- 
sons, and  thej^  are  more  severe  the  nearer  thej^  are  to  a  joint. 
The  healing  of  fractures  is  more  rapid  in  the  young  than  in  the 
old  and  in  the  upper  than  in  the  lower  extremity.  It  is  not 
proven  that  adiposity  of  itself  impedes  union. 

The  question  may  be  asked,  how  long  before  examination  a 
given  bone  was  fractured.  As  a  rule,  we  can  only  say  as  to 
whether  the  injured  person  has  lived  a  long  or  short  period 
since  the  injury,  as  the  process  of  repair  varies  according  to 
age  and  constitution.  No  changes  occur  until  eighteen  to 
twenty-four  hours,  when  lymph  is  exuded.     According  to  Vil- 

'  Taylor  :  "  Medical  Jurisprudence, "  -  London  Med.  Gaz. ,  vol.  xvi. , 

11th  American  Edition  (1892) .  p.  596. 


47G  WOUNDS — WOOLSEY. 

lerme  the  callus  is  cartilaginous  anywhere  between  the  six- 
teenth and  twenty-fifth  days,  it  becomes  ossified  between  three 
weeks  and  three  months,  and  it  takes  six  to  eight  months  to 
become  like  normal  bone. 

The  question  may  also  be  asked :  Has  a  bone  ever  been  frac- 
tured? The  existence  and  situation  of  a  fracture  can  often  be 
recognized  long  after  the  accident,  by  the  callus  or  slight  un- 
evenness  due  to  projection  of  the  edges  or  ends  of  the  fragments 
Where  the  bone  lies  deeply  covered  by  soft  parts,  it  is  difficult 
and  often  impossible  to  tell,  long  after  union  has  taken  place, 
whether  or  where  a  fracture  has  occurred. 

The  answering  of  this  question  may  sometimes  be  of  im- 
portance in  identifying  the  dead,  especially  in  the  case  of  skele- 
tons. In  the  latter  instance  by  sawing  the  bone  longitudinally 
we  can  tell  by  the  thickness,  irregularity,  or  structure  of  the 
bone  tissue  whether  a  fracture  existed,  and  if  it  were  recent  or 
old  at  the  time  of  death. 

Dislocations  call  for  a  medico-legal  investigation  less 
often  than  fractures.  They  are  less  common  in  the  old  and 
where  the  bones  are  brittle,  when  fracture  occurs  more  readily. 
They  are  seldom  fatal  per  se,  unless  between  the  vertebrje  or 
when  compound.  They  may  occur  from  disease  in  the  affected 
joint  or  even  spontaneously.  The  diagnosis  of  a  dislocation  is 
easy  until  it  has  been  reduced,  and  then  it  may  leave  no  trace 
except  pain  in  and  limitation  of  the  motion  of  a  joint  besides 
swelling  and  ecchymosis.  These  effects  are  transient,  and  after 
they  have  disappeared  it  may  be  impossible  to  say  whether  a 
dislocation  has  existed  on  a  living  body,  unless,  as  sometimes 
occurs,  especially  in  the  shoulder  joint,  there  may  be  a  tempo- 
rary or  permanent  paralysis  of  a  nerve  and  muscular  atrophy. 
After  death,  the  existence  of  an  old  dislocation  may  often  be 
recognized  on  dissection  by  scar  tissue  in  and  about  the  capsule. 

EXAMINATION  AND  DESCRIPTION. 

The  examination  of  wounds  or  injuries  in  a  case  which  is 
or  may  become  the  subject  of  a  medico-legal  investigation 
should  be  made  with  particular  care  and  exactness. 

As  the  examination  of  the  wounded  person  is  to  give  most, 
and  in  some  cases  all,  the  information  to  the  medical  expert  on 


EXAMINATION  AND   DESCRIPTION.  477 

which  he  is  to  base  his  testimony,  it  should  be  made  with 
reference  to  all  the  possibilities  of  the  case. 

The  particular  variety  of  wound  as  described  in  the  forego- 
ing section  should  be  noted,  and  any  peculiarities  as  to  its  situa- 
tion, shape,  extent,  length,  breadth,  depth,  direction,  and  the 
parts  involved.  Besides  these  points,  the  condition  of  the  edges 
of  the  wound,  whether  swollen  and  ecchj^motic,  smooth  and 
straight  or  dentated  and  irregular,  and  whether  inverted  or 
everted  and  gaping,  are  matters  of  importance.  The  presence 
or  absence  of  coagula  and  clots,  the  staining  of  the  tissues  with 
blood,  the  presence  of  ecchymosis  and  its  comparative  age,  as 
shown  by  its  color,  should  also  be  noted. 

Many  of  the  above  points  help  us  in  solving  another  prob- 
lem, namely,  the  form  of  the  instrument  used.  This  question 
will  be  discussed  in  a  subsequent  section,  but  the  basis  for  our 
opinion  is  founded,  of  course,  on  an  examination  of  the  partic- 
ulars of  the  wound.  The  solution  of  still  another  question 
which  often  arises  and  which  will  be  discussed  in  the  next 
section,  namely,  whether  a  wound  was  produced  before  or 
after  death,  is  based  upon  particular  features  of  the  wound  such 
as  the  fluid  or  clotted  condition  of  the  blood  on  the  surface,  or 
ecchymosed  in  the  tissues,  also  the  amount  of  the  hemorrhage 
as  compared  to  the  vascularity  of  the  part  as  well  as  the  greater 
or  less  staining  of  the  tissues  with  blood,  and  the  conditions  of 
the  edges,  whether  inverted  or  everted  and  whether  or  not  re- 
tracted. The  question  as  to  whether  a  wound  was  directly, 
secondary  or  necessarily  the  cause  of  death,  is  determined,  in 
part  at  least,  b}^  examination  of  the  wound.  In  this  connection 
we  take  note  as  to  whether  a  wound  has  opened  or  divided  a 
large  vein  or  artery  or  is  situated  in  such  a  vascular  part  as  to 
be  fatal  from  hemorrhage.  We  also  note  whether  death  could 
have  been  due  to  shock  from  the  situation  of  the  wound,  or 
whether  an  inflammation  wdiicli  was  directly  responsible  for 
death  was  necessarily  due  to  the  wound,  as  in  case  of  a  pene- 
trating wound  of  the  viscera,  etc.  Further,  we  note  whether 
one  of  the  manj^  forms  of  wound  diseases  from  infection  of  the 
wound  has  complicated  the  case  and  caused  death  in  the  case 
of  a  wound  not  otherwise  necessarily  fatal.  It  may  be  added 
that  often  the  necropsy  aids  us  in  the  solution  of  the  ouestion 
as  to  whether  the  wound  was  the  necessary  and  direct  cause 


478  WOUNDS — WOOLSEY. 

of  death,  by  showing  a  healthy  or  diseased  condition  of  the 
viscera. 

The  question  as  to  which  of  a  number  of  injuries  was  first 
inflicted,  also  as  to  the  relative  position  of  the  victim  and 
assailant,  can  be  answered,  if  at  all,  only  by  an  accurate  and 
close  examination  of  the  wounds. 

Finally,  the  most  important  question  of  all,  from  a  medico- 
legal standpoint,  namely,  the  distinction  between  homicidal, 
suicidal,  and  accidental  wounds,  is  decided  or  inferred  from  the 
characteristics  of  the  wound  after  careful  examination. 

All  the  foregoing  questions  contribute  to  the  solution  of  this 
the  most  important  one.  The  various  questions  referred  to 
above  will  be  considered  at  greater  length  in  the  subsequent 
sections.  They  have  been  merely  referred  to  in  brief  above, 
to  show  the  various  lines  of  thought  a  medical  examiner  must 
have  in  mind  in  making  an  examination. 

As  to  the  act  of  examination  itself,  the  phj^sician  should 
conduct  it  in  such  a  way  as  not  to  harm  the  wounded  person. 
Often  simple  inspection  is  the  most  that  can  be  done,  or  the 
examination  may  have  to  be  deferred  altogether  until  the  phy- 
sician in  charge  informs  the  court  that  an  examination  may  be 
safely  made.  It  is  often  necessary  for  the  expert  to  get  infor- 
mation as  to  the  original  lesion  from  the  physician  in  charge. 
If  the  wound  has  been  a  fatal  one  and  if  we  are  called  in  after 
death,  we  may  examine  the  wound  on  the  dead  body  with  much 
more  freedom.  Here  we  may  examine  the  depth,  direction, 
etc.,  of  a  punctured  wound  by  cutting  down  on  a  probe  or 
director.  After  careful  inspection  of  the  wound  we  may  ex- 
amine it  by  palpation,  and  go  on  to  the  dissection  of  the  wound 
and  the  surrounding  parts,  tracing  and  noting  the  various 
vessels,  muscles,  etc.,  involved  in  the  wound,  and  looking  for 
the  presence  of  any  foreign  body  in  the  wound. 

Furthermore,  if  the  cause  of  death  be  at  all  obscure,  we 
should  examine  not  only  the  wound  itself  and  the  parts  about 
the  wound,  but  also,  by  an  autopsy,  all  the  cavities  and  organs 
of  the  body.  For  death  may  have  been  due  to  natural  causes 
in  an  organ  not  examined,  if  the  examination  has  not  included 
all,  and  the  physician  has  to  disprove  it. 

In  examining  at  an  autopsy  the  depth  of  a  wound  in  refer- 
ence to  the  instrument  which  caused  it,  it  should  be  borne  in 


EXAMINATION  AND   DESCRIPTION.  479 

mind  that  the  wound  may  be  deeper  than  the  weapon  owing  to 
a  depression  of  the  surface  by  the  handle  of  the  weapon.  This 
may  appear  especially  marked  in  the  case  of  the  movable  viscera, 
as  at  the  time  of  the  accident  the  viscus  may  have  been  as  near 
as  possible  to  the  surface,  and  at  the  examination  as  far  as 
possible  from  the  surface,  as  in  the  case  of  a  given  coil  of  the 
intestines.  Also  the  thorax  when  opened  at  autopsy  enlarges 
or  expands  a  little,  so  that  the  measured  depth  of  a  wound  may 
be  greater  than  the  weapon  which  caused  it.  Vibert  *  mentions 
a  case  of  a  penetrating  wound  of  the  thorax  involving  the  heart, 
where  the  measured  depth  of  the  wound  was  0"'.035  greater 
than  the  length  of  the  instrument.  This  may  also  be  accounted 
for  by  a  depression  or  flattening  of  the  thorax  by  the  blow,  as 
in  the  case  of  soft  parts.  It  is  often  difficult  in  an  examination 
to  measure  accurately  the  depth  of  a  wound,  for  one  may  find 
it  hard  to  determine  the  precise  end  of  a  wound.  Also,  for 
exact  measurement  it  is  necessary  to  have  the  parts  in  the  same 
position  as  at  the  time  of  the  accident,  and  these  parts  are  more 
or  less  displaced  by  the  necessary  dissection. 

Besides  the  examination  of  the  wound  there  are  other  points 
the  examination  of  which  may  aid  us  in  solving  the  problems 
presented  by  a  case.  Among  these,  the  examination  of  the 
clothing  or  dress  is  perhaps  the  most  important.  This  may  in- 
dicate the  weapon  used  in  an  incised  or  punctured  wound. 
Contused  and  lacerated  wounds  or  fractures,  etc.,  may  be  pro- 
duced without  injuring  the  clothing.  Blood,  dirt,  or  grease  on 
the  clothing  may  throw  light  on  the  case.  In  self-inflicted 
wounds  the  wound  in  the  clothing  and  that  on  the  body  may 
not  and  often  do  not  correspond,  as  an  intending  suicide  often 
(a  murderer  rarely)  opens  the  clothing  to  select  the  spot  for  the 
wound.  The  wound  in  the  dress  is  then  added  by  a  second 
blow  not  corresponding  to  the  first.  In  this  way  we  may 
sometimes  distinguish  between  a  homicidal  and  suicidal  wound, 
and  thus  remove  a  false  suspicion  of  murder  or  show  that  a 
wound  was  self-inflicted  to  conceal  other  crimes  or  to  falsely 
impute  it  to  another.  The  suspicion  of  homicide  in  accidental 
wounds  maj^  be  cleared  up  by  an  examination  of  the  dress,  as  in 
the  following  instance  related  by  Taylor :  * 

'  Cli.  Vibert :  "  Precis  de  Medecine  '^  Taylor's      "  Medical      Jurispru- 

Legale,"  2d  Ed.,  p.  205.  dence,"  11th  Amer.  Ed.,  1892. 


480  WOUNDS — WOOLSEY. 

A  woman  was  found  dead  in  bed  with  two  indentations 
about  the  middle  of  the  right  parietal  bone,  a  large  superficial 
clot  here  and  three  ounces  of  clotted  blood  between  the  dura 
mater  and  skull,  which  latter  was  fractured  over  an  area  of  four 
inches.  No  other  cause  of  death  was  found.  The  evidence 
brought  out  the  facts  that  she  had  been  knocked  down  the 
evening  before,  about  7 :  30  o'clock,  by  a  man  accidentally  run- 
ning into  her.  She  fell  on  the  back  of  the  head,  was  stunned, 
raised  up,  and  stimulated ;  she  then  walked  home,  ate  her  supper, 
and  was  last  seen  at  9  o'clock  by  a  fellow-lodger  who  let  her  in 
and  noticed  nothing  unusual.  The  next  morning  she  had  evi- 
dently been  dead  some  time.  Suspicion  fell  upon  the  lodger, 
who  had  often  quarrelled  with  her,  and  the  two  claws  of  a  ham- 
mer found  in  his  room  corresponded  more  or  less  closely  with 
the  two  indentations  found  in  the  skull.  At  the  adjourned 
inquest,  however,  the  bonnet  worn  by  the  deceased  at  the  time 
of  the  accident  was  found  to  have  two  indentations  on  the  back 
of  it  corresponding  to  those  on  the  woman'  s  skull  and  contain- 
ing dust  and  dirt,  and  rendering  probable  what  from  the  history 
seemed  unlikely,  that  the  fall  in  the  road  caused  the  fatal 
injury.  The  examination  of  the  dress  thus  avoided  an  unjust 
accusation  of  murder. 

Contused  and  lacerated  w^ounds  and  fractures  or  dislocations 
may  be  produced  without  injury  to  the  dress,  especially  if  the 
latter  be  elastic  or  yielding.  The  comparison  of  the  wound  in 
the  clothes  with  that  on  the  body  may  indicate  the  position  of 
the  body  at  the  time  of  the  blow.  The  examination  of  the 
clothes  of  the  injured  person  may  indicate  a  struggle  which 
would  support  the  idea  of  homicide.  A  blunt  instrument  may 
indirectly  cause  an  injury  by  striking  something  in  or  on  a 
person's  clothes.  Instances  have  been  reported  where  a  wound 
has  been  caused  by  an  article  in  the  pocket,  or  worn  outside  the 
clothing,  without  any  trace  of  an  injury  to  the  clothes  or  pocket 
lining.' 

The  examination  of  the  dress  may  further  show  which  of 
several  cuts  or  stabs  was  first  inflicted.  This  is  shown  by  the 
staining  of  the  edges  of  the  cuts  in  the  clothing,  the  edges  of 
the  first  cut  or  stab  showing  no  blood-stain  or  onlj'^  on  the  inner 

'  London  Lancet,  Jan.  21st,  1893,  and  N.  Y.  Med.  Journal,  March  11th, 
1893,  and  May  13th,  1893. 


EXAMINATION   AND    DESCRIPTION.  481 

surface,  as  the  knife  is  clean  of  blood  on  entering  and  all  that  is 
removed  by  the  clothing  on  its  withdrawal  is  found  on  the 
inner  edges.  If  the  edges  of  the  cuts  in  the  outer  layers  of 
clothing  are  bloody,  it  is  evident  that  the  knife  was  already 
bloody  when  used,  and  the  corresponding  wound  was  not  the 
first  inflicted. 

The  imprint  of  the  bloody  hand  of  the  assailant  may  some- 
times be  found  on  the  clothing  of  the  one  injured,  and  is  espe- 
cially important  as  evidence,  when  the  hands  of  the  assaulted 
are  not  bloody.  In  the  case  of  a  severe  wound,  especiall}'  if 
it  is  likely  to  become  the  object  of  a  criminal  investigation,  the 
physician  should  always  require  to  see  the  dress  of  the  wounded. 
The  examination  of  the  clothing  which  the  accused  wore  at  the 
time  the  assault  took  place  may  give  important  evidence  by 
showing  evidences  of  a  struggle  or  blood-stains.  Absence  of 
the  latter  would  not  prove  the  innocence  of  the  accused,  as  the 
clothes  actually  worn  may  be  destroyed  and  others  substituted, 
or  the  marks  and  stains  may  be  removed.  In  the  latter  case, 
the  eye  of  a  medical  man  may  detect  traces  of  blood  which 
otherwise  would  go  unnoticed,  and  a  microscopical  and  chemi- 
cal examination  would  reveal  the  real  character  of  the  stain. 

Besides  the  examination  of  the  clothing  of  the  accused,  the 
examination  of  his  person  may  furnish  evidence  of  his  being 
engaged  in  a  more  or  less  desperate  struggle  by  the  scratches, 
marks  of  nails,  contusions,  bites,  etc.,  on  the  face,  neck,  front 
of  chest,  forearms,  and  hands.  If  the  accused  should  attempt  to 
explain  these  wounds  and  spots,  the  latter  may  or  may  not 
verify  the  explanation,  and  thus  additional  evidence  may  be 
obtained  as  to  the  guilt  or  innocence  of  the  accused. 

It  is  well  for  the  medical  expert,  as  well  as  for  others,  to 
collect  the  statements  of  the  wounded  person  relative  to  the 
circumstances  of  the  injury.  Also,  if  the  accused  will  vouchsafe 
any  such  statements  we  may  compare  these  with  one  another 
and  with  the  facts  indicated  by  the  wound,  etc. 

Other  points  to  examine,  especially  in  cases  of  suspected 
suicide,  may  be  briefly  mentioned.  The  presence  of  the  weapon 
in  the  hand  of  the  victim  and  firmly  grasped  in  general  indi- 
cates suicide,  if  it  corresponds  to  the  weapon  causing  the 
wounds,  for  otherwise  it  may  have  been  used  for  defence.     If 

not  in  the  hand,  note  the  spot  where  the  weapon  was  found. 
31 


483  WOUNDS — WOOLSEY. 

In  the  case  of  a  suicide,  the  hand  as  well  as  the  weapon  held 
by  it  is  likely  to  be  bloody,  also  in  case  of  murder  the  generally 
empty  hand  is  apt  to  be  bloody,  as  the  hand  is  naturally  carried 
to  the  wound. 

We  cannot  further  describe  the  many  points  which  the 
medical  examiner  should  bear  in  mind  in  making  an  examina- 
tion in  a  medico-legal  case,  without  repeating  too  fully  what 
will  be  given  at  greater  length  in  subsequent  sections,  reference 
to  which  should  be  made  for  further  particulars.  Tardieu  pro- 
posed as  a  basis  for  examining  and  studying  wounds,  (1)  to 
visit  the  wounded  person  and  see  what  state  he  is  in,  and  to 
determine  (2)  the  nature,  (3)  the  cause,  (4)  the  consequences 
of  the  wound.  Also  if  the  wounded  person  is  dead  (5)  to  ex- 
amine the  body  for  the  cause  of  death  in  order  to  see  if  the 
latter  is  due  to  the  wound.  Also  (6)  to  determine  thee  ircum- 
stances  of  the  affray. 

The  description  of  a  wound  should  be  given  in  plain 
language,  avoiding  the  use  of  scientific  terms  or  expressions,  so 
as  to  be  readily  understood  by  judge  and  jurors.  Otherwise 
the  usefulness  of  the  medical  expert  is  very  much  decreased. 
The  description  should  also  be  precise  and  sufficient  to  justify 
the  conclusions  arrived  at  as  to  the  cause  of  a  wound,  its  gravity 
and  results,  and  the  weapon  used.  With  a  view  to  exact  state- 
ment in  description,  it  is  well  to  take  notes  as  to  the  result  of 
the  examination  and  not  depend  merely  on  memory.  The  ob- 
ject of  the  witness  should  be  to  be  understood  and  not  to  be 
thought  thoroughly  scientific. 

WAS  THE   INJURY  INFLICTED  BEFORE  OR  AFTER  DEATH? 

This  is  a  question  which  may  often  be  asked  in  cases  of  fatal 
injuries,  and  it  is  one  which  must  be  answered  as  definitelj'  as 
we  are  able,  for  the  defence  may  rest  on  the  assertion  that  the 
wound  or  injury  was  post  mortem  and  not  ante  mortem.  What 
are  the  means  we  have  to  enable  us  to  answer  the  above  ques- 
tion? The  most  important  factor  is  the  condition  of  the  blood 
and  the  changes  that  it  undergoes  after  death.  For  some  hours 
after  death  the  body  retains  its  animal  heat.  As  long  as  this 
is  retained  rigor  mortis  does  not  set  in  and  the  blood  is  more 
or  less  fluid.     This  period  varies,  but  on  the  average  it  does  not 


HEMORRHAGE.  483 

last  longer  than  eight  or  ten  hours.  Before  this  time,  however, 
the  blood  has  begun  to  undergo  certain  changes.  These  changes 
result  in  the  inability  of  the  blood  from  a  post-mortem  wound 
to  coagulate  completely.  At  first  the  greater  part  may  coag- 
ulate, but  after  a  time  coagulation  is  less  and  less  complete, 
and  the  coagula  are  not  as  firm  as  those  from  the  blood  of  a 
living  person.  The  period  at  which  these  changes  occur  also 
varies,  but  they  may  generally  be  clearly  noticed  in  from  three 
to  four  hours  after  death,  or  even  sooner.  In  the  first  two  to 
four  hours  after  death,  therefore,  as  far  as  the  condition  of  the 
blood  is  concerned,  it  may  be  difficult  or  impossible  to  say 
whether  a  wound  was  made  before  or  soon  after  death.  In 
other  words,  this  difficulty  exists  as  long  as  the  tissues  of  the 
body  live  after  the  body  as  a  whole  is  dead. 

There  are  certain  general  pathological  or  occasional  condi- 
tions of  the  body  in  which  the  blood  during  life  does  not  coag- 
ulate at  all  or  only  imperfectly,  as  in  scurvy  and  in  the  case  of 
the  menstrual  blood.  Also  blood  in  a  serous  cavity,  especially 
if  it  be  abundant  or  there  exists  inflammation,  is  found  not 
to  coagulate  or  onty  imperfectly.  Post  mortem  the  blood  re- 
mains liquid  long  after  death  in  cases  of  death  by  drowning, 
asphyxia,  etc.,  and  in  such  cases  hemorrhage  may  be  free  in 
a  wound  made  some  time  after  death.  Furthermore,  after 
putrefaction  has  set  in  the  blood  again  becomes  more  or  less 
liquid,  and  may  flow  away  from  a  wound  like  a  hemorrhage, 
but  it  no  longer  coagulates. 

The  principal  signs  of  a  wound  inflicted  during  life  are  (1) 
hemorrhage,  (2)  coagulation  of  the  blood,  (3)  eversion  of  the 
lips  of  the  wound,  and  (4)  retraction  of  its  sides. 

1.  Hemorrhage  varies  in  amount  with  the  size  of  the 
wound,  the  vascularity  of  the  part,  and  the  number  and  size  of 
the  large  vessels  involved.  In  incised  or  punctured  wounds  the 
amount,  as  a  rule,  is  quite  considerable.  If  there  is  a  free  exit 
most  of  the  blood  runs  off;  the  rest  stays  in  the  wound,  Avhere  it 
soon  coagulates  with  the  exceptions  mentioned  above.  But  be- 
sides partly  filling  the  wound  in  the  form  of  a  clot,  the  edges  of 
the  wound  are  deeph'  stained  with  the  coloring  matter  of  the 
blood,  and  this  stain  cannot  be  removed  b}'  washing.  This 
staining  involves  especially  the  muscular  and  cellular  tissues. 

Further,  a  hemorrhage  during  life  is  an  active  and  not  a 


484  WOUNDS — WOOLSEY. 

passive  one;  the  blood  is  forced  into  the  interspaces  of  the 
tissues  in  the  vicinity  of  the  wound,  and  is  found  infiltrated  in 
the  cellular  tissue,  the  muscles,  the  sheaths  of  the  vessels,  etc. 
It  is  here  incorporated,  as.  it  were,  with  the  tissues  so  that  it 
cannot  be  washed  away.  In  an  ante-mortem  wound  the  arte- 
rial nature  of  the  hemorrhage  may  show  by  the  marks  of  the 
jets  of  blood  about  the  wound  or  on  the  clothes  or  surrounding 
objects.  When  a  large  vessel  has  been  divided  and  the  exit 
for  the  blood  is  free,  this  may  run  off  without  infiltrating  the 
tissues  or  even  staining  the  edges  to  any  considerable  extent, 
and  there  may  remain  but  little  in  the  wound.  In  the  case  of 
lacerated  and  contused  wounds  the  amount  of  hemorrhage  is 
less,  but  rarely  fails  entirely,  and  if  the  wound  is  in  a  vascular 
part  it  is  liable  to  cause  death  from  hemorrhage,  though  a  whole 
limb  may  possibly  be  torn  off  without  much  hemorrhage.  In 
the  latter  case,  however,  there  are  usually  found  clots  of  blood 
adhering  to  the  edges  of  the  lacerated  wound  and  the  ends  of 
the  vessels.  In  contusions  where  there  is  no  wound  of  the 
skin  the  blood  is  prevented  from  flowing  externally,  and  its 
accumulation  and  distribution  form  an  ecchymosis.  Here 
again  we  see  the  active  power  of  the  hemorrhage  which  infil- 
trates between  the  tissues,  stains  them  deeply,  and  appears 
either  as  a  mere  stain  or  in  fine  clots  incorporated,  as  it  were, 
with  the  tissues  or  partly  occupying  a  cavity  formed  by  an 
extensive  displacement  of  the  surrounding  parts.  The  amount 
of  blood  varies  under  the  same  conditions  as  in  incised  wounds, 
and  also  according  to  the  greater  or  less  disintegration  of  the 
tissues  by  the  blow,  allowing  a  larger  or  smaller  central  cavity 
to  be  formed.  In  "bleeders"  the  amount  of  the  hemorrhage 
does  not  vary  under  the  normal  conditions,  but  a  fatal  hemor- 
rhage may  occur  from  a  very  insignificant  wound.  After  hem- 
orrhage from  a  wound  made  during  life  the  veins  are  empty 
about  the  wound,  especially  those  situated  centripetally,  while 
normally  after  death  the  blood  is  mostly  aggregated  in  the  veins. 
They  are  the  source  of  post-mortem  hemorrhage,  but  do  not 
empty  themselves  to  any  great  extent. 

The  hemorrhage  from  a  ivound  made  after  death  may  be 
extensive  if  the  blood  remains  fluid  as  in  the  cases  mentioned 
above,  i.e.,  after  death  from  drowning  or  asphyxia  or  after 
the  commencement  of  putrefaction.     Otherwise  the  amount  of 


CADAVERIC   ECCHYMOSES.  485 

hemorrhage  decreases  with  the  length  of  time  after  death,  until 
the  blood  loses  its  fluidity  and  hemorrhage  no  longer  occurs. 
In  general,  it  is  slight  unless  a  large  vein  is  opened,  for  the 
veins  are  the  source  of  the  hemorrhage.  There  is  usually 
scarcely  any  hemorrhage  after  the  first  two  to  four  hours.  This 
applies  also  to  subcutaneous  hemorrhages  or  ecchymoses.  These 
post-mortem  hemorrhages  are  passive  and  not  active,  conse- 
quentlj'  there  is  less  infiltration  of  blood  into  the  surrounding 
tissues,  which  merely  imbibe  it,  and  the  stain  is  less  deep  and 
may  be  washed  off  the  edges  of  the  wound,  in  contrast  to  the 
stain  of  ante-mortem  wounds.  After  putrefaction  has  set  in 
the  hemorrhage  may  be  more  abundant,  as  the  blood  is  driven 
to  the  surface  by  the  formation  of  gas  in  the  abdomen  and 
thorax.  At  the  saiue  time,  the  coloring  matter  of  the  blood 
transudes  through  the  walls  of  the  veins  and  is  imbibed  by 
and  stains  the  tissues,  so  that  it  may  be  impossible  to  dis- 
tinguish it  from  a  true  ecchymosis.  Fortunately  these  con- 
ditions are  of  small  moment,  as  an  examination  is  seldom 
deferred  so  long. 

Cadaveric  ecchymoses  show  almost  invariably  while  the 
body  is  still  warm  and  the  blood  more  or  less  liquid,  i.e.,  during 
the  first  eight  or  ten  hours  after  death.  They  are  not  due  to 
injury  or  violence  before  or  after  death,  but  they  may  closely 
resemble  ecchymoses  produced  on  the  living  body  and  be  mis- 
taken for  them.  This  is  the  more  important  as  they  are  quite 
constant  on  the  cadaver. 

In  this  connection,  it  may  be  said  that  an  ecchymosis  due 
to  a  blow  before  death  may  not  show  till  after  death,  as  it 
requires  some  time  for  a  deep  ecchymosis  or  even  an  ecchymosis 
covered  by  a  thick  layer  of  skin  to  show  superficially.  Thus  a 
man  kicked  in  the  abdomen  died  thirty-five  hours  after  the  in- 
jury from  peritonitis,  due  to  a  rupture  of  the  bladder.  No 
ecchymosis  appeared  at  the  site  of  the  injuries  until  after  death. 
It  is  not  uncommon  in  cases  of  hanging  to  observe  an  ecchy- 
mosis along  the  course  of  the  cord  appearing  only  after  death. 
Huize  met  with  a  case  of  this  description.  Devergie  remarked 
that  on  the  bodies  of  those  drowned  ecchymoses  are  often  hidden 
for  a  time  on  account  of  the  sodden  state  of  the  skin,  and  they 
appear  only  after  the  water  has  evaporated,  which  may  require 
some  days.     Furthermore,  it  is  not  necessary  to  survive  long 


486  WOUNDS — WOOLSEY. 

after  an  injury  in  order  that  an  ecchymosis  may  show  post 
mortem.  If  the  blood  is  fluid  at  the  time  of  the  blow  and  any 
capillaries  or  larger  blood-vessels  are  torn,  then  we  may  have 
an  ecchymosis  though  death  be  almost  instant.  Casper  thought 
that  it  required  some  time  before  death  for  an  ecchymosis  to 
develop,  and  that  if  the  person  injured  by  a  contusion  died  soon 
after  the  injury,  an  ecchymosis  would  not  appear  after  death. 
There  are  many  well-authenticated  cases  to  prove  that  Casper's 
opinion  is  wrong.  Among  the  most  famous  of  these  is  that  of 
the  Duchesse  de  Praslin.'  She  was  attacked  and  killed  by  her 
husband  while  she  was  asleep  in  bed.  The  thirty  or  so  wounds 
showed  a  mortal  conflict,  and  she  could  not  have  survived  more 
than  one-half  hour,  and  yet  after  death  there  were  'numerous 
ecchymoses  from  the  contusions. 

Another  case  is  also  mentioned  by  Taylor.*  A  young  man 
died  suddenly  after  a  blow  from  a  companion,  having  been 
struck  in  the  side  a  fortnight  before  by  a  heavy  box,  which 
knocked  him  senseless  and  nearly  killed  him.  The  post  mortem 
revealed  an  ecchymosis  on  the  side  which  on  the  authority  of 
Casper's  opinion  was  attributed  to  the  old  injury.  The  color 
of  the  ecchymosis  would  be  sufiicient  to  settle  all  such  doubts, 
as  the  changes  of  color  would  have  fully  developed  or  the 
color  even  disappeared  in  part  in  fourteen  days'  time. 

An  ecchymosis  made  post  mortem  does  not  undergo  the  color 
changes  seen  in  ecchymoses  during  life,  unless  the  tissues  are 
oedematous  in  which  the  ecchymosis  occurs.  These  changes  in 
color  have  already  been  described,  the  deep  blue  changing  to 
violet  in  eighteen  to  twenty-four  hours  at  the  earliest.  In  sup- 
port of  the  foregoing  and  disproving  Casper's  views,  Christison 
found  that  within  two  Jiours  after  death  severe  blows  on  a  dead 
body  are  followed  by  a  livid  discoloration,  similar  to  those  pro- 
duced by  a  blow  shortly  before  death.  This  livid  discoloration  is 
due  to  the  effusion  of  a  very  thin  layer  of  blood  external  or  super- 
ficial to  the  true  skin,  sometimes  in  a  stratum  of  the  true  skin 
or  more  rarely  into  the  cellular  tissue,  staining  deeply  the  par- 
tition walls  of  the  fat-cells.  Of  course,  a  more  or  less  recent 
contusion  or  ecchymosis  on  a  dead  body  was  not  necessarily 
produced  at  the  same  time  as  the  cause  of  death.     It  should 

'Ann.  d'Hyg.,  1847,  t.  2,  p.  377.  ^  Tajdor :      "Medical      Jurispru- 

dence," 11th  Amer.  Ed.,  1892. 


POST-MORTEM   ECCHYMOSES.  487 

be  borne  in  mind  in  this  connection  that  ecchymcsis  is  not  a 
necessary  result  of  a  blow  or  contusion. 

According  to  Devergie,  ecchymosis  does  not  appear  when  a 
blow  inflicted  post  mortem  is  received  by  skin  directly  covering 
a  bony  surface  beneath,  and  rarely  appears  where  there  is  a 
large  amount  of  fat  and  no  solid  point  of  resistance  beneath  the 
site  of  the  blow. 

We  have  already  referred  to  the  fact  which  Portal  long  ago 
remarked,  namely,  that  the  spleen  has  been  ruptured  without 
ecchymosis  or  abrasion  of  the  skin.  The  same  absence  of 
ecchymosis  has  been  noticed  in  cases  where  the  liver,  stomach, 
intestines,  bladder,  etc.,  have  been  ruptured  as  the  result  of  con- 
tusing blows. 

The  following  case  cited  by  Taylor '  illustrates  this  point. 
Henke  reported  the  case  of  a  man  who  died  of  peritonitis  a  few 
hours  after  fighting  with  another  man.  There  was  no  mark  on 
the  skin  or  ecchymosis,  though  there  existed  peritonitis  from 
rupture  of  the  small  intestine.  The  blow  was  proven  by  direct 
evidence,  and  though  some  medical  witnesses  on  account  of  the 
absence  of  external  signs  thought  that  no  blow  could  have  been 
struck,  others  of  more  experience  admitted  that  it  could  have 
been  the  cause  of  the  rupture. 

Watson  "^  reports  a  similar  case  of  a  girl  nine  years  old  who 
received  a  blow  from  a  shoe  on  the  abdomen.  This  was  fol- 
lowed by  great  pain,  collapse  and  death  in  twenty-one  hours. 
No  marks  of  injury  were  visible  externally,  but  peritonitis 
existed  from  rupture  of  the  ileum. 

A  similar  case  is  reported  by  Williamson,'  where  peritonitis 
resulted  from  complete  rupture  of  the  ileum  without  any  trace 
of  injury  externally,  though  the  blow  was  struck  by  the  hoof 
of  a  horse. 

Another  case  was  brought  into  Guy's  Hospital  *  who  had 
been  run  over  by  an  omnibus.  No  injury  was  discoverable, 
though  the  wheel  had  passed  over  the  chest  and  abdomen.  He 
died  of  peritonitis,  however,  which  set  in  on  the  second  day, 
and  on  post-mortem  examination  the  liver  and  small  intestines 
were  found  ruptured. 

'"Med.    Jurisprud.,"  lltli  Amer.  ^Med.  Gaz..  May,  1840. 

Ed.,  1892.  •»Guy'sHosp.  Gaz.,  1873. 

•^"On  Homicide,"  p.  187. 


488  WOUNDS — WOOLSEY. 

Christison  thought  as  the  result  of  his  experiments  and  ex- 
perience that  the  most  reliable  signs  of  an  ecchymosis  made 
during  life,  and  distinguishing  it  from  one  caused  by  a  blow 
after  death,  were  as  follows :  The  skin  of  the  ecchymosed  area 
is  generally  much  darkened  and  discolored  from  blood  infil- 
trated through  its  entire  thickness;  the  skin  is  also  much 
firmer  and  more  elastic  from  swelling  of  the  part  if  the  contu- 
sion is  received  some  hours  before  death.  But  we  may  have 
an  effusion  beneath  and  not  in  the  substance  of  the  skin,  and 
the  above  signs  might  possibly  be  due  to  an  injury  inflicted 
only  a  few  minutes  after  death.  The  above  signs  may  there- 
fore be  absent,  and  when  present  are  not  absolutely  indicative 
of  an  injury  received  dviring  life.  In  general,  the  effects  of 
severe  contusions  inflicted  soon  after  death  may  closely  resem- 
ble those  of  slight  contusions  received  during  life. 

There  is  little  danger  of  contusion  if  the  blow  be  inflicted 
on  a  dead  body  after  the  loss  of  body  heat  and  the  beginning 
of  rigor  mortis. 

2.  Coagulation  of  Blood. — As  stated  at  the  beginning  of 
this  section,  blood  from  a  wound  inflicted  during  life  coagulates 
with  the  exception  of  that  from  those  suffering  from  certain 
pathological  or  occasional  conditions  or  in  certain  locations, 
already  mentioned.  This  coagulation  is  not  immediate,  but  is 
complete  in  about  five  minutes.  The  entire  amount  of  blood 
lost  is  thus  coagulated  and  the  coagula  are  firm.  These  coagula 
(if  the  wound  is  not  interfered  with)  occur  in  the  opening  of  a 
wound  and  on  its  edges,  especially  at  the  mouths  of  the  blood- 
vessels, which  are  thus  plugged.  The  blood  which  infiltrates 
the  interspaces  of  the  tissues  is  coagulated  in  the  form  of  these 
interspaces.  The  same  is  true  of  the  blood  of  an  ecchj^mosis 
whether  there  be  a  hematoma  or  only  an  infiltration  between 
the  tissues,  or  both.  These  clots  represent  more  or  less  the 
form  of  the  space  occupied  by  the  blood.  In  the  case  of  the 
scalp  a  subcutaneous  clot  maj"  be  mistaken  for  a  depressed  frac- 
ture of  the  skull  from  the  fact  that  the  edges  of  the  clot  become 
very  hard  while  the  centre  is  still  quite  soft.  A  wound  in 
which  a  large  arterj^  has  been  divided  may  present  very  little 
clotting  in  the  wound  if  the  opening  is  free  and  the  blood  has 
mostly  escaped  in  a  jet. 

In  a  wound  jjroduced  soon  after  death  there  may  be  some 


COAGULATION    OF    BLOOD.  489 

clotting,  but  less  in  amount,  firstly,  because  there  is  less  hemor- 
rhage, and,  secondly,  because  not  all  the  blood  clots.  These 
conditions  increase  with  the  length  of  time  after  death,  so  that 
after  a  time  a  wound  made  on  a  cadaver  would  show  very 
little  if  any  clotting  owing  to  very  slight  hemorrhage,  and  lit- 
tle or  no  clotting  of  the  blood  extravasated.  When  the  body 
has  lost  its  animal  heat  and  rigor  mortis  has  begun  to  set  in, 
then  there  is  no  more  coagulation  of  the  blood  and  no  more 
hemorrhage,  under  normal  conditions,  for  the  blood  has  mostly 
become  clotted  in  the  vessels  of  the  body.  Consequenth^,  with 
the  exception  of  wounds  inflicted  very  soon  after  death,  we  can 
distinguish  an  ante-mortem  from  a  post-mortem  wound  by  the 
condition  in  which  the  blood  is  clotted.  If  there  is  any  hemor- 
rhage, the  wound  being  inflicted  before  the  loss  of  animal  Jieat 
and  the  blood  remains  entirely  fluid  on  the  surface  or  in  an 
ecchymosis,  we  know  that  the  wound  was  produced  after  death 
and  some  hours  after  death  unless  any  of  those  conditions  exist 
in  which  the  blood  does  not  normally  coagulate.  If  the  hem- 
orrhage is  slight  or  quite  moderate  in  amount  and  venous  in 
character,  if  the  blood  is  only  clotted  in  part  and  the  clots  are 
rather  soft  and  do  not  form  a  plug  at  the  mouth  of  each  artery, 
and  especially  if  the  staining  of  the  walls  of  the  wound  can 
be  washed  off,  then  the  wound  was  probably  produced  post 
mortem,  but  not  so  long  after  death  as  in  the  first  case  supposed. 
If  the  characters  of  the  hemorrhage  and  the  clotting  are  still 
more  like  those  normal  to  a  wound  inflicted  during  life,  then, 
as  a  rule,  it  is  impossible  to  say  from  these  two  features  of  the 
wound,  hemorrhage  and  clotting,  whether  the  wound  was  in- 
flicted during  life  or  a  very  short  time  after  death. 

3.  EvERSiON  OF  THE  LiPS  OF  THE  WouND. — The  edges  or 
lips  of  a  wound  inflicted  during  life  may  be  inverted,  instead  of 
everted,  if  a  thin  layer  of  muscular  flbres  is  attached  directly 
to  the  deep  surface  of  the  skin,  as  is  the  case  in  the  scrotum. 
The  eversion  of  the  edges  of  the  skin  is  due  to  their  elasticity, 
and  ceases  to  occur  as  soon  as  the  skin  loses  its  vitality.  Con- 
sequently eversion  ceases  to  occur  soon  after  death,  within  a 
very  few  hours.  A  wound  in  which  the  edges  are  neither  in- 
verted or  everted  was  therefore  inflicted  after  death.  If  this 
sign  is  present  and  marked,  the  wound  was  inflicted  during  life 
or  within  two  or  three  hours  or  less  after  death.     If  this  sign  is 


490  WOUNDS — WOOLSEY, 

present  but  very  slightly  marked,  the  wound  may  have  been 
made  even  somewhat  longer  after  death. 

4.  Retraction  of  the  sides  of  the  w^ound  is  also  de- 
pendent on  their  vitality  and  ceases  to  occur  when  this  is  lost  a 
few  hours  after  death.  In  the  retraction  of  the  edges  of  the 
wound  we  have  all  the  parts  involved,  but  unequally.  The 
muscles,  arteries,  skin,  and  layers  of  connective  tissue  all  re- 
tract, varying  in  the  degree  of  retraction  according  to  the  order 
in  which  they  are  named.  In  different  parts  of  the  body  this 
comparative  order  of  retraction  is  liable  to  more  or  less  varia- 
tion. Every  surgeon  is  familiar  with  this  retraction  of  the 
tissues,  which  necessitates  certain  rules  in  the  technique  of  oper- 
ations, especially  of  amputations.  Muscles  retract  the  more 
the  longer  they  are  and  the  farther  the  incision  is  made  from  their 
attachment.  Without  specifying  a  definite  time,  we  may  say 
that,  as  a  rule,  this  retraction  lasts  no  longer  than  about  two 
hours  after  death,  consequently  when  it  is  absent  we  may  infer 
that  the  wound  was  inflicted  two  hours  or  more  after  death.  The 
amount  of  retraction  grows  less  and  less  after  death  for  about 
two  hours,  after  which  it  is  very  slight  if  it  occurs  at  all,  owing 
to  the  loss  of  elasticity  of  the  tissues.  This  sign  is  especially 
useful  in  the  case  of  a  mutilated  body  where,  by  examining  the 
degree  of  retraction  of  the  muscles,  we  may  infer  whether  the 
mutilation  was  done  before  or  after  death.  The  sides  of  a  cut 
made  on  the  cadaver  are  comparatively  smooth  and  even,  owing 
to  the  absence  of  the  unequal  retraction  of  the  various  elements, 
which  makes  the  surfaces  of  a  gaping  ante-mortem  wound  un- 
even and  irregular.  Relying  on  these  circumstances  in  the 
"affaire  Ramus,"  cited  by  Vibert,*  one  was  able  to  recognize 
the  order  in  which  the  body  had  been  mutilated. 

Other  minor  signs  of  a  wound  inflicted  during  life  may  be 
briefly  mentioned.  If  the  edges  of  the  wound  are  swollen,  or 
show  signs  of  inflammation  or  gangrene,  or  if  pus  or  adhesive 
material  is  present  on  the  edges  of  the  wound,  we  may  infer 
that  the  wound  was  inflicted  some  little  time  before  death. 
Of  course,  if  cicatrization  has  commenced,  some  days  must 
have  elapsed  before  death  after  the  wound  was  received.  If 
the  blow  causing  a  contusion  was  inflicted  some  time  before 
death,  there  will  be  more  or  less  of  a  general  swelling  of  the 
'  Vibert :  "  Precis  de  Medecine  Legale, "  2d  Ed. ,  1890. 


OTHER  MINOR   SIGNS.  491 

region,  partly  due  to  the  blood  effused,  but  also  partly  due  to 
oedema. 

It  is  not  always  easy  to  say  whether  a  fracture  was  pro- 
duced while  the  body  was  living  or  dead.  If  the  body  was  stiU 
warm  when  a  post-mortem  fracture  was  produced  there  is  little 
difference  from  an  ante-mortem  fracture,  except  that  there 
may  be  a  little  less  blood  effused.  In  a  fracture  produced  after 
rigor  mortis  has  set  in  there  is  little  or  no  blood  effused.  In 
the  case  of  fractures  the  presence  of  callus,  indicating  the 
process  of  repair,  shows  that  the  accident  occurred  during 
life,  and,  as  we  have  already  seen,  we  may  form  some  idea  of 
the  length  of  time  elapsed  between  the  injury  and  the  time  of 
death.  On  the  cadaver  it  is  said  to  be  harder  to  cause  fractures 
and  lesions  of  the  skin  than  on  the  living  body.  Casper  says 
that  fractures  of  the  Iiyoid  bone  and  the  larynx  are  impossible 
after  death,  and  he  also  was  not  able  to  rupture  the  liver  or 
spleen. 

In  distinction  to  the  characteristic  signs  of  a  wound  inflicted 
during  life,  we  may  mention  briefly  some  of  the  signs  of  post- 
mortem wounds  when  the  wound  has  been  inflicted  from  two 
to  ten  or  twelve  hours  or  more  after  death : 

(1)  The  hemorrhage  is  slight  in  amount  and  may  fail  alto- 
gether. 

(2)  The  character  of  the  hemorrhage  is  venous,  correspond- 
ing to  the  source  of  the  hemorrhage  from  the  veins,  the  arteries 
being  nearly  empty  after  death. 

(3)  The  edges  of  the  wound  are  not  deeply  stained,  and  this 
staining  may  be  removed  by  washing.  The  spaces  between 
the  tissues  are  not  infiltrated  with  blood. 

(4)  The  blood  remains  either  entirely  fluid  or,  if  there  are 
clots,  these  are  softer  than  those  in  an  ante-mortem  wound,  and 
only  a  portion  of  the  blood  is  thus  clotted.  There  are  no  clots 
plugging  the  open  mouths  of  the  arteries  on  the  surface  of  the 
wound ;  the  veins  may  or  may  not  be  closed  by  an  imperfect  clot. 

(5)  The  skin  of  the  edges  is  not  everted  or  inverted. 

(6)  The  sides  of  the  wound  do  not  gape  and  their  surfaces 
are  smooth  and  even,  as  the  tissues  are  not  unevenly  retracted. 

Resume. — It  is  very  easy  from  the  foregoing  to  distinguish 
between  a  wound  inflicted  before  death  and  one  ten  or  twelve 
hours  after  death. 


492  WOUNDS — WOOLSEY. 

If  the  hemorrhage  has  been  abundant  and  arterial,  if  it  has 
infiltrated  between  and  deeply  stained  the  tissues  and  the  stain 
cannot  readily  be  washed  off;  if  the  blood  coagulates  com- 
pletely and  the  coagula  are  firm  and  are  found  lying  in  the 
wound,  plugging  the  vessels,  and  incorporated  with  the  tissues 
between  which  they  lie ;  if  the  edges  of  the  skin  are  everted 
and  the  sides  of  the  wound  are  retracted  and  uneven — under 
these  circumstances,  we  may  be  sure  that  the  wound  was  in- 
flicted during  life  or  a  very  short  time  after  death.  If,  on  the 
contrary,  the  hemorrhage  is  slight  in  amount  or  almost  fails 
altogether ;  if  it  is  venous  in  character ;  if  the  edges  of  the 
wound  are  only  stained  by  imbibition  of  the  blood,  which  is  not 
infiltrated  between  the  tissues,  and  the  stain  may  be  washed 
off;  if  the  blood  is  not  at  all  or  only  slightly  clotted  and  the 
clots'  are  soft ;  if  the  skin  is  not  everted  and  the  sides  of  the 
wound  are  smooth  and  lie  nearly  in  contact ;  if  there  are  no 
clots  plugging  the  divided  arteries  on  the  surface — then  we 
need  have  little  hesitancy  in  saying  that  the  wound  was  pro- 
duced after  death,  but  probably  not  later  than  ten  or  twelve 
hours  after  death.  If  the  wound  was  inflicted  still  longer  after 
death  and  before  putrefaction,  then  we  would  have  a  lack  of 
the  signs  due  to  hemorrhage,  clots,  staining,  etc.  If  we  find 
the  conditions  more  or  less  midway  between  the  first  two,  we 
may  be  left  in  some  doubt  as  to  the  date  of  the  injury.  Thus 
if  the  hemorrhage  is  moderate,  the  blood  mostly  but  not  alto- 
gether clotted  and  the  clots  moderately  firm,  the  skin  slightly 
everted,  and  the  sides  slightly  separated  and  not  altogether 
smooth  on  their  surface ;  if  the  surfaces  are  fairly  deeply  stained 
and  the  stain  cannot  be  easily  washed  off — then  we  can  onlj^ 
say  that  the  wound  was  inflicted  during  life  or  within  two 
hours  or  so  after  death,  and  this  fact  is  often  enough  for  the 
purposes  of  the  medico-legal  inquiry. 

The  same  is  the  case  with  contusions  where  there  is  no 
bleeding  externally.  If  we  have  a  bluish,  violet,  green,  or  yellow 
tumor  with  or  without  more  or  less  superficial  oedema ;  if  this 
tumor  fluctuates  or  is  hard,  but  in  either  case  is  elastic ;  if  on 
incision  the  skin  and  the  tissue  spaces  are  infiltrated  with  blood 
which  is  coagulated,  or  if  there  is  a  cavity  filled  with  clotted 
blood,  the  coagulum  being  firm  and  the  entire  amount  of  blood 
coagulated — then  the  wound  was  inflicted  during  life.     If,  how- 


CERTAIN   ACTS   AFTER  FATAL  INJURT.  493 

ever,  the  surface  shows  a  bhiish  or  violet  color,  little  or  no 
swelling  of  the  skin,  which  is  of  natural  thickness,  and  the 
ecchymosed  area  is  not  tense  and  elastic  to  the  touch ;  if  further 
the  blood  is  found  on  incision  to  be  fluid  or  if  coagulated  only 
partly  so,  and  the  blood  is  not  infiltrated  into  the  tissue  spaces, 
but  merely  imbibed  by  the  tissues — then  the  blow  was  inflicted 
after  death,  and  probably  more  than  two  or  three  hours  after. 

In  contusions  especially  we  may  have  difficulty,  as  the  sign 
of  fluidity  of  the  blood  may  fail  and  putrefaction  may  modify 
the  conditions  of  the  wound  unless  parts  deep  beneath  the  sur- 
face be  examined. 

We  see,  then,  that  in  some  cases  it  is  very  easy  to  say  that  a 
wound  was  inflicted  post  mortem.  If  a  wound  was  not  inflicted 
until  ten  or  twelve  hours  after  death  or  even  sooner,  we  cannot 
easily  mistake  it.  But  in  many  cases  it  may  be  hard  or  im- 
possible to  say  whether  a  wound  was  inflicted  during  life  or 
within  an  hour  or  two  after  death.  Here  we  must  be  cautious 
in  expressing  an  opinion  which  should  be  guarded.  But  we 
should  remember  that  it  is  important  to  be  able  to  state  that  a 
wound  was  inflicted  before  or  immediately  after  death,  as  no 
one  but  a  murderer  would  think  of  inflicting  a  fatal  injur}"  on 
a  body  immediately  after  death.  In  such  cases  a  well-guarded 
medical  opinion  may  often  meet  all  the  requirements  of  the 
case. 

Granted  that  a  given  wound  was  produced  before  death. 
There  are,  then,  one  or  two  questions  which  may  arise,  and 
which  depend  for  their  answer  on  the  length  of  time  the 
wounded  person  could  have  lived  and  the  phj^siological  or  mus- 
cular acts  which  he  could  have  performed  after  receiving  the 
injury  and  before  death.  The  first  of  these  questions  may 
be  expressed  as  follows : 

Could  the  Victim  have  Performed  Certain  Acts  after 
Having  Received  his  Fatal  Injury?  The  term  "certain 
acts  "  here  refers  to  almost  any  thing  or  things  which  would 
require  time  and  strength — in  other  words,  the  continuance  of  life 
with  bodily  and  mental  powers  for  a  certain  time  after  receiv- 
ing a  mortal  injury. 

This  question  may  be  raised  in  relation  to  an  attempted 
alibi  of  the  accused,  who  may  have  been  proved  to  be  in  the 
presence  of  the  victim  a  moment  before  death.     If  after  this 


494  WOUNDS — WOOLSEY. 

moment  the  victim  has  moved  from  the  spot  or  performed  cer- 
tain acts  before  death,  the  attempted  alibi  may  depend  upon 
the  answer  to  the  question  as  to  whether  the  given  acts  of  the 
victim  were  compatible  with  the  fatal  character  of  the  wound. 
An  alibi  can  aid  in  the  acquittal  of  the  accused  only  when  the 
nature  of  the  injury  was  such  that  death  would  be  supposed  to 
be  immediate  or  nearl}'-  so.  Great  care  should  be  taken  on  the 
part  of  the  medical  witness  in  answering  this  question,  for  after 
very  grave  wounds,  proving  speedily  fatal,  the  victim  some- 
times can  do  certain  acts  requiring  more  or  less  prolonged 
effort,  as  shown  by  numerous  examples.  Wounds  of  the  brain 
are  especially  noticeable  in  allowing  a  survival  of  several  hours, 
days,  or  even  weeks,  during  which  time  the  injured  person  may 
pursue  his  occupations.  Where  the  survival  has  lasted  da^'S  or 
weeks,  the  alibi  has  no  importance,  but  not  if  the  survival  is 
of  shorter  duration.  The  following  case  is  cited  by  Vibert* 
and  may  be  mentioned  in  this  connection,  though  the  wound 
was  caused  by  a  bullet  which  traversed  from  behind  forward 
the  entire  left  lobe  of  the  brain.  After  the  injury  the  victim 
was  seen  by  several  witnesses  to  climb  a  ladder,  though  with 
difficulty,  for  he  had  right-sided  hemij)legia.  He  was  found 
insensible  more  than  half  a  mile  away,  and  did  not  die  until 
six  or  eight  hours  after  the  injury.  Severe  injury  of  impor- 
tant organs  is  sometimes  not  incompatible  with  an  unexpectedh' 
long  survival.  Devergie  cites  two  illustrations  of  this  which 
are  quoted  by  Vibert.'  A  man  received  several  extensive 
fractures  of  the  skull,  with  abundant  sub-dural  hemorrhage, 
and  rupture  of  the  diaphragm  with  hernia  of  the  stomach. 
The  stomach  was  ruptured,  and  nearly  a  litre  of  its  contents 
was  contained  in  the  left  pleural  cavity.  Notwithstanding  all 
this,  he  was  able  to  walk  about  for  an  hour  or  so  and  answer 
several  questions.  He  died  only  after  several  hours.  Another 
man,  crushed  by  a  carriage,  received  a  large  rupture  of  the  dia- 
phragm, complete  rupture  of  the  jejunum,  and  rupture  and 
crushing  of  one  kidney.  Yet  he  walked  nearly  five  miles,  and 
did  not  die  until  the  next  day. 

More  rarelj'  wounds  of  the  great  vessels  are  not  immediately 
fatal.     M.  Tourdes  is  quoted  by  Vibert '  as  citing  the  case  of 
a  man  who  descended  a  flight  of  stairs  and  took  several  steps 
1  Vibert :   "  Precis  de  Medecine  Legale, "  2d  Ed. ,  1890. 


CERTAIN   ACTS   AFTER   FATAL   INJURY.  495 

after  division  of  the  carotid  artery ;  also  of  one  who  lived  ten 
minutes  after  a  bullet-wound  of  the  inferior  vena-cava. 

Even  wounds  of  the  heart  are  not  as  speedily  fatal  as  is 
commonly  supposed,  and  often  permit  of  a  comparatively  long 
survival. 

Fischer '  found  only  104  cases  of  immediate  death  among 
452  cases  of  wounds  of  the  heart,  and  healing  occurred  in  50 
cases  among  401.  Vibert^  mentions  two  striking  cases  of  long 
survival  after  wounds  of  the  heart.  A  woman  received  a  stab- 
wound  which  perforated  the  right  ventricle,  causing  a  wound 
one  centimetre  long.  She  did  not  die  until  twelve  days  later, 
when  on  autopsy  there  was  found  an  enormous  extravasation 
of  blood  in  the  left  pleural  cavity  and  pericardium.  The  second 
case,  though  one  of  bullet-wound,  is  equally  applicable  and 
instructive  in  this  connection.  A  man  received  a  bullet-wound 
which  perforated  the  left  ventricle,  the  bullet  being  found 
later  in  the  pericardium.  After  being  wounded  he  threw  a 
lamp  at  his  assassin  which  set  fire  to  the  room.  He  then 
went  into  the  court-3'ard,  drew  some  water,  carried  it  back 
in  a  bucket,  extinguished  the  fire,  and  then  lay  down  on  his 
bed  and  died. 

In  studying  the  wounds  of  different  regions  of  the  bod}', 
we  may  find  many  other  mortal  wounds  which,  though  speedily 
fatal,  leave  the  possibility  of  more  or  less  activity  before  death. 
We  see,  therefore,  that  even  in  those  wounds  which  are  com- 
monly supposed  to  be  immediately  fatal,  even  by  man}-  medical 
men  where  attention  has  not  been  called  to  the  exceptions,  such 
exceptional  cases  are  not  uncommon  in  which  death  is  not 
immediate.  Time  and  even  strength  may  thus  be  allowed  for 
more  or  less  complicated  activity.  An  alibi  cannot,  therefore, 
be  allowed  without  question  on  the  part  of  the  medical  expert, 
who  must  exercise  great  caution  in  expressing  an  opinion. 
The  second  question  which  may  sometimes  arise  in  connection 
with  the  last,  but  having  little  to  do  with  the  subject  of  this 
section,  is  the  following: 

How  Long  before  Death  had  the  Deceased  Accoji- 
PLisHED  Certain  Physiological  Acts?    For  instance,  how 

'  Vibert :"  Precis  de  Medecine  Le-  *  Quoted     bv    Vibert    from     the 

gale,"  2d  Ed.,  1890.  "Traite  do  pa'thologie  extenie  "   of 

Folliu  and  Duplay. 


496  WOUNDS — WOOLSEY. 

long  after  a  meal  did  he  die?  This  is  hard  to  answer  with  pre- 
cision, as  digestion  varies  with  the  individual,  and  digestion 
begun  during  life  may  go  on  to  a  certain  extent  after  death.  We 
may  be  able  to  say  if  digestion  has  just  commenced,  is  well  ad- 
vanced, or  has  terminated.  What  was  eaten  at  the  last  meal 
may  be  learned  by  the  naked  eye,  the  microscope,  the  color  of 
stomach  contents  and  their  odor.  The  state  of  the  bladder  and 
rectum  is  sometimes  called  in  question.  All  the  above  facts 
have  less  bearing  on  the  case  than  those  in  relation  to  the 
former  question. 

THE  CAUSE  OF  DEATH  FROM  WOUNDS. 

The  cause  of  death  should  be  certain  and  definite.  In  reality, 
there  is  only  one  real  cause,  though  one  or  many  circumstances 
may  be  accessory  causes.  In  most  cases  of  death  from  the  class 
of  wounds  which  we  have  been  considering,  there  is  no  difficulty 
in  determining  the  cause  of  death  so  as  to  be  able  to  state  it 
definitely.  But  if  the  deceased  had  recovered  from  the  first 
effects  of  the  wound  and  then  died,  or  if  death  seems  as  much 
due  to  disease  as  to  injury,  then  the  real  cause  of  death  may 
be  obscure.  If  the  medical  witness  is  in  doubt  as  to  which  of 
two  causes  was  the  primary  cause  of  death  the  doubt  should  be 
stated  at  once,  as  it  may  weaken  the  testimony  if  brought  out 
later. 

Wounds  may  be  directly  or  indirectly  fatal.  They  are 
directly  fatal  if  the  victim  dies  at  once  or  very  soon  after  the 
wound,  with  no  other  cause  internally  in  his  body  or  externally 
from  his  environment.  Wounds  are  indirectly  or  secondarily 
fatal  if  the  injured  person  dies  from  a  wound  disease  or  com- 
plication, the  direct  consequence  of  the  wound,  or  from  a  surgi- 
cal operation  necessary  in  the  treatment  of  the  case.  Wounds 
may  also  be  necessarily  fatal  either  directly  or  secondarily,  or 
not  necessarily  fatal.  In  the  latter  case  death  may  be  due  as 
much,  if  not  more,  to  other  causes  than  the  wound,  and  some- 
times not  at  all  to  the  wound  itself.  Thus  death  may  be  due  to 
natural  causes,  latent  disease,  an  unhealthy  state  of  the  body, 
imprudence  or  neglect  of  treatment,  or  improper  treatment,  etc. 
These  various  degrees  of  responsibility  of  a  wound  as  the  cause 
of  death  we  will  now  consider  more  at  length. 


THE    CAUSE    OF    DEATH    FROM    WOUNDS.  49?' 


I.  Was  the  Wound  the  Cause  of  Death  Directly? 

If  so,  it  must  have  caused  death  in  one  of  the  following- 
ways: 

1.  Hemorrhage. — This  may  act  by  producing  syncope. 
But  the  amount  of  the  hemorrhage  may  not  be  suflScient  for 
this  result,  and  still  cause  death  by  disturbing  the  function  of 
the  organ  into  which  it  is  effused,  as  in  the  brain  or  in  the 
pleural  or  pericardial  cavities.  The  blood  here  acts  mechani- 
cally. Blood  in  the  trachea  may  also  kill  mechanically  by 
causing  asphyxia. 

The  amount  of  hemorrhage  required  to  produce  syncope 
varies  under  a  variety  of  circumstances.  Less  is  required  in 
the  very  young,  the  aged,  and  the  diseased,  also  less  in  women 
than  in  men.  Young  infants  may  die  from  hemorrhage  from 
very  slight  wounds,  even  from  the  application  of  a  leech  or  the 
lancing  of  the  gums.  A  sudden  loss  of  blood  is  much  more 
serious  than  an  equal  amount  lost  slowly.  This  is  the  reason 
that  the  wound  of  an  artery  is  more  serious  and  more  rapidly 
fatal  than  a  similar  loss  of  blood  from  other  sources.  It  is  hard 
to  specify  the  absolute  quantity  which  must  be  lost  in  order  to 
cause  death  by  syncope.  The  total  blood  in  the  body  is  about 
one-thirteenth  of  the  weight  of  the  body,  making  the  total  amount 
of  blood  weigh  about  twelve  pounds.  Of  this,  about  one-fourth 
is  in  the  heart,  lungs,  and  large  blood-vessels.  According  to 
Watson,  the  loss  of  an  amount  varying  from  five  to  eight 
pounds  is  enough  to  be  fatal  to  an  adult.  But  less  is  enough  to 
prove  fatal  in  many  cases,  as  the  rapidity  of  the  loss  of  blood 
and  the  age,  sex,  and  bodily  condition  of  the  wounded  person 
affect  the  amount  necessary.  Though  death  from  a  small  artery 
is  slower  than  that  from  a  large  one,  yet  it  may  occur  in  time, 
as  shown  in  the  instance  quoted  by  Taylor, '  where  a  man  bled 
to  death  in  thirty-eight  hours  from  the  wound  of  an  intercostal 
artery.  Thus,  too,  a  wound  of  the  branches  of  the  external 
carotid  artery  is  often  enough  to  cause  death,  and  a  wound  in 
a  vascular  part  may  cause  death  from  hemorrhage,  though  no 
vessel  of  any  size  be  divided. 

Internal  hemorrhage  may  be  fatal  from  mechanical  in- 

'"Med.  Jurisprud. , "  11th  Amer.  Ed.,  1892. 
32 


498  WOUNDS — WOOLSEY. 

terference  with  the  function  of  an  organ,  as  well  as  from  syn- 
cope. Thus  we  may  have  death  from  syncope  due  to  hemor- 
rhage into  the  peritoneal  cavity  or,  after  contusions,  into  the 
intercellular  spaces  and  the  cavity  due  to  the  blow,  into  which 
several  pounds  of  blood  may  be  extravasated.  Internal  hemor- 
rhage is  most  fatal  when  due  to  the  rupture  of  a  viscus  such  as 
the  heart,  lungs,  liver,  kidney.  Taylor  ^  cites  a  case  of  a  man 
run  over  and  brought  to  Guy's  Hospital  in  November,  1864. 
He  had  pain  in  the  back,  but  there  were  no  symptoms  or  marks 
of  severe  injury.  He  left  the  hospital  and  walked  home,  where 
he  was  found  dead  in  bed  a  few  hours  later.  His  abdomen 
contained  a  large  amount  of  blood  from  the  rupture  of  a  kidney. 
After  severe  flagellation  blood  may  be  effused  in  large  quan- 
tity beneath  the  skin  and  between  the  muscles,  which  is  just  as 
fatal  as  if  it  had  flowed  externally  from  a  wound.  In  fact,  if 
the  injuries  are  numerous  the  loss  of  much  less  blood  is  enough 
to  prove  fatal,  the  element  of  shock  here  assisting  that  of  hem- 
orrhage. 

Hoiv  are  ive  to  ascertain  tvhether  a  person  has  died  from 
hemorrhage  ?  This  may  be  more  difficult  in  the  case  of  an 
open  wound,  for  the  body  may  have  been  moved  from  the  spot 
where  it  lay  after  the  wound  was  received,  and  the  blood  on 
the  body,  clothes,  and  surrounding  objects  may  have  been  re- 
moved. Then  the  case  may  be  presumptive  only,  but  we  may 
arrive  at  a  definite  conclusion  by  attention  to  the  following 
points :  If  the  wound  was  in  a  very  vascular  part  and  of  some 
size,  or  if  a  large  vessel  or  many  moderately  large  vessels  were 
divided  and  the  vessels,  especially  the  veins  in  the  neighbor- 
hood, are  empty,  then  we  may  be  quite  sure  of  death  from 
hemorrhage.  If  there  is  no  disease  found  which  could  be 
rapidly  fatal  the  case  is  still  stronger.  The  body  should  be 
pallid  after  fatal  hemorrhage,  but  the  same  may  be  the  case 
from  death  from  other  causes.  In  case  the  body  and  surround- 
ing objects  have  not  been  disturbed,  then  the  amount  of  clotted 
blood  in  the  wound,  on  the  body  and  clothes,  and  about  the 
body,  taken  in  connection  with  the  foregoing  points,  can  leave 
no  doubt.  We  should  remember,  however,  that  not  all  the 
blood  about  the  bod}^  was  necessarily  effused  during  life,  but  a 
little  hemorrhage  may  have  occurred  after  death  while  the 
'"Med.  Jurispmd.,"  11th  Amer.  Ed.,  1892. 


SEVERE   MECHANICAL   INJURY   OF   A   VITAL   ORGAN.       499 

body  was  still  warm  and  the  blood  fluid,  i.e.,  during  the  first 
four,  eight,  or  ten  hours.  But  the  amount  thus  lost  is  small. 
In  cases  of  death  from  internal  hemorrhage  we  do  not  have  so 
much  difficulty  in  pronouncing  an  opinion,  as  by  post-mortem 
examination  we  can  determine  the  amount  of  the  hemorrhage. 
We  can  judge,  too,  from  its  position,  whether  it  iias  acted 
mechanically  to  interfere  with  a  vital  function,  and  has  thus 
caused  death,  or  whether  the  latter  was  due  to  syncope  from 
the  quantity  lost. 

2.  Severe  mechanical  injury  of  a  vital  organ,  such 
as  crushing  of  the  heart,  lungs,  brain,  etc.  This  crushing 
may  be  accompanied  by  hemorrhage,  but  death  may  be  more 
immediate  than  the  hemorrhage  would  account  for.  The  me- 
chanical injury  done  to  the  vital  centres  in  the  medulla  by  the 
act  of  pithing  is  the  direct  cause  of  the  sudden  death  which 
follows  it.  Exceptionally  slight  violence  to  a  vital  organ  is 
fatal,  but  this  may  be  better  explained  by  attributing  it  to  shock. 

3.  Shock. — An  injury  is  often  apparently  not  enough  to 
account  for  the  fatal  result  so  speedily.  The  marks  of  external 
injury  may  fail  entirely  or  be  very  trifling.  Thus  more  than 
once  persons  have  died  in  railway  collisions  with  no  external 
marks  of  violence.  So,  too,  a  blow  on  the  upper  abdomen,  on 
the  "  pit  of  the  stomach, "  has  been  rapidly  fatal  without  any 
visible  injury  to  the  viscera.  Death  is  attributed  to  the  effect 
on  the  cardiac  plexus,  and  there  may  be  no  marks  externally 
or  only  very  superficial  ones.  In  Reg.  v.  Slane  and  Others 
(Durham  Wint.  Ass.,  1872),  quoted  by  Taylor,'  the  deceased 
was  proved  to  have  sustained  severe  injuries  to  the  abdomen 
by  kicks,  etc.,  but  there  were  no  marks  of  bruises.  All  organs 
were  found  healthy  on  post-mortem  examination,  but  the  in- 
jured man  died  in  twenty  minutes.  Death  was  attributed  to 
shock  and  the  prisoners  were  convicted  of  murder. 

Death  from  concussion  of  the  brain  is  another  example  of 
death  from  shock.  This  may  occur  with  only  a  t)ruise  on  the 
scalp  and  with  no  intracranial  hemorrhage  or  laceration  of  the 
brain.  The  medical  witness  should  be  cautious  in  the  above 
classes  of  cases  in  giving  evidence,  as  the  defence  may  rely 
upon  the  absence  of  any  visible  signs  of  mortal  injury  to  prove 
that  no  injury  was  done,  a  principle  fundamentally  wrong. 
'"Med.  Jurisprud. , "  11th  Amer.  Ed.,  1892. 


500  WOUNDS — WOOLSET. 

Also  a  number  of  injuries,  no  one  of  which  alone  could  be 
the  direct  cause  of  death,  may  cause  death  on  the  spot  or  very- 
soon  afterward.  Death  in  such  cases,  where  there  is  no  large 
effusion  under  the  skin,  is  referred  to  exhaustion,  which,  how- 
ever, is  merely  another  term  for  shock.  Such  cases  are  exem- 
plified by -prize-fighters  who,  during  or  after  the  fight,  become 
collapsed  and  die  of  exhaustion.  Having  sustained  numerous 
blows  on  the  body  during  the  many  rounds,  the  body  presents 
the  marks  of  various  bruises,  but  there  may  be  nothing  else 
to  explain  the  sudden  death.  No  one  injury  or  bruise  is  mortal, 
and  yet,  when  the  deceased  was  previously  sound  and  in  good 
health,  death  must  be  referred  directly  to  the  multiple  injuries 
received  in  the  fight.  We  have  already  stated  above  that  if 
the  injuries  are  numerous,  the  loss  of  a  smaller  amount  of  blood 
may  be  fatal.  We  see,  therefore,  that  there  is  not  always  a 
specific  and  visible  "mortal"  injury  to  account  for  death.  This 
is  a  well-kno\^Ti  medical  fact,  but  it  does  not  accord  with  the 
erroneous  popular  prejudice  that  no  one  can  die  from  violence 
without  some  one  visible  wound  which  is  mortal.  In  other 
words,  the  non-professional  mind  leaves  out  of  account  the  idea 
of  shock,  only  regarding  material  injury  and  not  functional  dis- 
turbance. If  the  circumstances  accompanying  death  are  un- 
known, it  is  well  to  be  cautious.  But  if  the  deceased  was  in 
ordinary  health  and  vigor  and  there  was  no  morbid  cause  to 
account  for  the  sudden  death,  we  need  not  hesitate  to  refer 
death  to  the  multiple  injuries. 

II.  Was  the  Wound  the  Cause  of  Death  Necessarily? 

This  brings  up  a  number  of  interesting  questions  to  be  con- 
sidered. In  medical  jurisprudence  there  is  probably  no  condition 
so  common  as  that  the  injurj'-  is  admitted,  but  death  is  attrib- 
uted to  some  other  cause.  Thus  if  there  are  several  ivounds  it 
may  be  hard^to  decide  on  the  relative  degree  of  mortality  of  an}- 
particular  one,  so  as  to  be  able  to  say  that  death  was  directly  or 
necessarily  due  to  this  or  that  one.  The  defence  may  plead  that 
death  was  not  necessarily  due  to  the  particular  wound  attrib- 
uted to  the  prisoner.     This  brings  up  the  question — 

Which  of  two  or  more  Wounds  was  the  Cause  of 
Death?     No  general  rule  can  be  laid  down  for  all  cases,  but 


WAS   THE   WOUND   THE   CAUSE   OF   DEATH  ?  501 

each  case  must  be  judged  by  itself.  Another  way  of  put- 
ting the  question  is :  "  Which  of  two  or  more  icounds  ivas 
mortal?"  The  questions  are  not  quite  synonymous,  for  two 
or  more  of  the  wounds  might  be  "  mortal"  but  not  equally  the 
cause  of  death.  In  fact,  as  we  have  alread}-  seen,  no  one  of  the 
wounds  if  they  are  multiple  may  be  of  itself  mortal,  but  taken 
together  they  are  so.  Consequently  we  will  suppose  that  there 
are  but  two  wounds,  and  not  multiple  ones,  and  the  question 
remains  which  of  these  wounds  was  the  cause  of  death.  A 
wound  may  be  said  to  be  of  itself  mortal  when  it  is  the  cause 
of  death  directly  or  indirectly  in  spite  of  the  best  medical  as- 
sistance. In  some  continental  states  mortal  wounds  are  divided 
into  two  classes,  those  absolutely  and  those  conditionally  mor- 
tal, the  former  including  those  in  which  the  best  medical  as- 
sistance is  at  hand,  sent  for  or  timely  rendered  without  everting 
the  result.  The  mortal  result  in  the  second  class  is  conditional 
on  want  of  treatment,  improper  treatment,  or  accidental  cir- 
cumstances. As  Taylor  says,  it  is  better  to  look  at  the  effect 
of  the  wound  and  the  intent  of  the  assailant,  as  is  done  in 
English  law,  rather  than  at  accidental  relations  of  the 
wound. 

To  return  to  the  question,  we  can  readily  imagine  that  a 
man  may  receive  two  wounds  at  different  times  or  from  differ- 
ent persons,  and  die  after  the  second  wound.  Taylor '  mentions 
the  following  case  in  which  the  question  arose  as  to  which  of 
two  injuries  caused  death:  In  Reg.  v.  Foreman  (C.C.C.  Feb- 
ruary, 1873)  the  prisoner  had  struck  the  deceased  some  severe 
blows  on  the  head.  A  fortnight  later,  having  partially  recov- 
ered, another  man  gave  him  some  severe  blows  on  the  head. 
A  fortnight  later  still  he  had  left  hemiplegia,  and  died  a  few 
days  later  of  a  large  abscess  in  the  brain.  The  question  arose 
which  set  of  blows  had  been  the  cause  of  the  abscess.  The 
prisoner,  the  first  assailant,  was  acquitted,  as  the  deceased  had 
had  no  serious  symptoms  until  the  second  assault,  and  there 
was  no  satisfactory  medical  evidence  as  to  the  relation  of  the 
two  assaults  to  the  abscess  formation.  The  same  author  also 
supposes  the  following  case :  A  man  having  received  a  gunshot 
wound  of  the  shoulder  is  doing  well,  when  in  another  quarrel 
he  receives  a  penetrating  stab- wound  of  the  thorax  and  abdo- 
'  Taylor:  "Medical  Jurisprudence,"  11th  Amer.  Ed.,  1893. 


502  WOUNDS — WOOLSEY. 

men.  He  dies  after  lingering  for  a  timo,  under  the  effects  of 
these  wounds.  If  the  wound  of  the  shoulder  could  be  proven 
to  be  the  cause  of  death,  the  second  assailant  could  not  be  con- 
victed of  manslaughter,  and  so  too  with  the  first  assailant  if 
it  could  be  shown  that  the  victim  died  of  the  stab-wound.  It 
might  be  possible  for  a  surgeon  to  decide  the  question  definiteh' 
at  once  if  death  occurred  soon  after  the  stab,  which  was  found 
to  have  penetrated  the  heart,  a  large  blood-vessel,  or  one  of  the 
viscera ;  or,  on  the  other  hand,  if  the  stab- wound  was  found  to 
be  superficial  and  not  penetrating,  and  the  wound  in  the  shoul- 
der had  suppurated  and  caused  septicemia. 

In  either  or  any  case,  everything  would  depend  upon  the 
evidence  furnished  by  the  medical  witness.  His  knowledge 
and  judgment  are  required  to  distinguish  the  guilty  from  the 
innocent. 

Again,  sometimes  death  may  appear  to  be  equally  the  result 
of  either  or  both  wounds,  in  which  case,  as  far  as  the  medical 
evidence  goes,  both  assailants  would  be  liable  to  the  charge  of 
manslaughter.  Or  the  second  wound  may  be  accidental  or  sui- 
cidal, and  again  the  question  would  arise  as  to  the  cause  of 
death.  A  case  illustrating  this  is  told  by  Taylor  *  substantially 
as  follows :  A  grocer's  assistant  pursued  a  thief,  who  had  stolen 
from  a  cart,  into  a  coal-shed,  where  he  was  stabbed  twice  in 
the  abdomen.  The  larger  wound  suppurated,  the  smaller  wound 
healed  up,  and  the  man  died  of  peritonitis.  On  post-mortem 
examination  the  suppurating  wound  was  found  not  to  involve 
a  vital  part,  while  the  small  healed  wound  had  wounded  the 
liver  and  gall  bladder  and  had  set  up  the  fatal  peritonitis. 
The  large  suppurating  wound  had  apparently  been  inflicted 
purposely;  the  fatal  wound,  directed  upward  and  backward, 
might  have  been  accidental  by  the  deceased  rushing  upon  the 
knife  held  more  or  less  in  self-defence.  The  case  never  came 
to  trial,  as  the  assailant  was  never  found,  but  it  can  be  readih' 
Imagined  what  complications  might  have  arisen. 

Furthermore,  the  wounded  person  may  have  taken  poison  or 
been  subsequently  ill-treated,  and  he  may  have  died  from  these 
causes  rather  than  the  injury.  But  the  question  arises  as  to 
whether  the  wound  was  necessarily  the  cause  of  death.  Here, 
in  order  to  exculpate  the  assailant,  the  supervening  disease  or 
'Taylor:  "  MedicalJurisprudence, "  11th  Amer.  Ed.,  1893. 


WAS    DEATH    DUE    TO    NATURAL   CAUSES?  503 

maltreatment  must  be  such  as  to  account  for  sudden  or  rapid 
death  under  the  symptoms  which  actually  preceded  death. 

Was  Death  Due  to  Natural  Causes?  Again,  the  injury 
may  be  admitted,  but  it  may  be  claimed  that  death  is  due  to  nat- 
ural causes.  It  is  not  unusual  for  wounded  persons  to  die  from 
natural  causes,  though  the  case  may  appear  otherwise  to  lay- 
men. This  is  often  seen  with  suicidal  wounds,  especially  those 
inflicted  during  the  delirium  of  a  disease,  or  the  disease  may 
supervene  later  and  cause  death  without  relation  to  the  wound. 
Where  the  wound  was  inflicted  by  another,  accurate  discrimi- 
nation is  especially  important  in  order  to  save  the  accused  from 
imprisonment  under  false  accusation  and  consequent  loss  of 
character.  A  careful  examination  is  the  only  way  to  determine 
such  cases,  which  depend  therefore  on  the  medical  testimony. 

Again,  the  question  may  arise  as  between  death  from 
WOUNDS  OR  LATENT  DISEASE,  the  wound  perhaps  being  ad- 
mitted, but  death  being  attributed  to  latent  disease.  Here  a 
close  attention  to  symptoms  and  a  careful  post-mortem  exami- 
nation can  alone  decide.  A  man  may  die  from  the  rupture  of 
an  aneurism,  from  an  apoplexy  or  some  other  morbid  condi- 
tion after  receiving  a  severe  wound.  Or  a  man  with  a  hernia 
may  receive  a  blow  upon  it  causing  a  rupture  of  the  contained 
intestine  followed  by  peritonitis  and  death,  or  the  recipient  of 
a  blow  may  have  a  calculus  in  the  kidney  which  ma}'  perforate 
a  blood-vessel  or  the  kidney  tissue  and  set  up  a  fatal  hemor- 
rhage as  the  result  of  a  blow. 

Thus,  medically  speaking,  the  result  of  the  injury  is  un- 
usual and  unexpected,  and  due  to  an  abnormal  or  unhealthy 
state  of  body  of  the  wounded  person. 

If  it  can  be  clearly  shown  by  the  medical  testimony  that 
death  was  due  to  the  above  or  anj^-  other  latent  diseases,  the 
responsibilitj^  of  the  assailant  may  be  lessened  or  removed. 
The  law  looks  to  this  point  and  is  lenient  in  its  punishment 
in  the  absence  of  malice  on  the  part  of  the  assailant.  The 
crime  is  still  manslaughter  and  may  even  be  murder  if  the 
assailant  was  actuated  by  malice  and  the  abnormal  or  unhealthy 
state  of  the  body  of  the  victim  was  taken  advantage  of. 
Generally  there  is  no  intention  of  murder,  but  the  nature  of 
the  wound  and  the  means  of  infliction  will  help  to  show  this, 
which  is  for  the  jury  rather  than  the  medical  witness  to  decide. 


504  WOUNDS — WOOLSEY. 

There  is  less  ground  for  mitigation  of  the  punishment  if  the 
assailant  was  aware  of  the  peculiar  condition  of  the  wounded 
person,  especially  in  the  case  of  those  notoriously  ill  or  of 
pregnant  women. 

Closely  allied  with  this  subject  are  those  rare  cases  where 

ABNORMAL  ANATOMICAL  CONDITIONS,  SUch   aS  a  thin   skuU   or 

brittle  bones,  cause  a  slight  injury  to  be  followed  by  unexpect- 
ed and  untoward  results,  not  to  be  looked  for  in  the  average  in- 
dividual. In  such  cases  the  evidence  of  the  abnormal  condition 
furnished  by  the  medical  witness  may  diminish  the  responsi- 
bility and  mitigate  the  punishment. 

Furthermore,  the  responsibility  of  the  assailant  may  not  be 
altogether  removed,  for  the  question  naturally  arises.  Was  death 
accelerated  by  the  wound?  This  depends  upon  the  circum- 
stances in  each  case  upon  which  the  medical  witness  must  base 
his  opinion.  Maliciously  accelerating  the  death  of  another  is 
regarded  as  criminal  on  the  principle  that  that  which  acceler- 
ates causes.  The  following  cases  are  quoted  from  Taylor  *  to 
illustrate  the  above  distinctions.  In  Reg.  v.  Timms  (Oxford 
Lent  Ass.,  1870)  the  deceased  had  been  struck  on  the  head  by 
the  accused  with  a  hatchet,  from  which  injury  he  had  partly 
recovered  under  treatment  in  twelve  days.  But  six  weeks  later 
he  was  seized  with  inflammation  of  the  brain,  with  convulsions, 
and  died.  At  the  autopsy  disease  of  the  kidneys  was  found, 
and  death  was  referred  to  this  and  the  inflammation  of  the 
brain  due  to  the  blows.  The  prisoner  was  convicted  after  the 
judge  had  charged  the  jury  that  it  was  manslaughter  if  they 
believed  that  the  blows  conduced  in  part  to  the  death  of  the 
deceased. 

In  the  following  cases  there  was  no  connection  between  the 
violence  and  the  cause  of  death.  A  man  struck  his  father  on 
the  head  with  a  hammer  and  was  sentenced  to  two  months'  im- 
prisonment, as  the  injury  did  not  appear  serious.  The  father 
thought  the  punishment  too  little,  became  much  excited,  and 
was  hemiplegia  six  days  after  the  wound  was  inflicted  and 
died  three  days  later.  No  injury  of  the  brain  was  found  under 
a  fracture  of  the  inner  table  at  the  site  of  the  blow,  but  a  large 
clot  was  found  in  the  lateral  ventricle  which,  in  the  opinion  of 
the  medical  witnesses,  was  not  dependent  on  the  blow,  and  the 
1  Taylor:   "MedicalJurisprudence,"  11th  Amer.  Ed.,  1892. 


WAS    DEATH    DUE    TO    NATURAL   CAUSES?  505 

prisoner  was  acquitted  (see  Reg,  v.  Saxon,  Lancashire  Sum. 
Ass.,  1884).  Also  in  Reg.  v.  Hodgson  (Leeds  Sum.  Ass.,  187G) 
the  prisoner  had  struck  his  wife  with  a  belt,  a  short  time  after 
which  she  fell  back  and  died  suddenly.  The  cause  of  death 
was  found  to  be  heart  disease,  and  the  blow  not  being  causative 
in  producing  the  fatal  result,  the  prisoner  was  acquitted.  Or 
again  in  Reg.  v.  Thompson  (Liverpool  Sum.  Ass.,  1876):  The 
prisoner  had  stabbed  his  wife  in  the  cheek.  The  wound  was 
severe  but  not  mortal.  Two  days  later  she  was  delivered  of  a 
child  in  the  infirmary  to  which  she  was  taken.  She  died  nine 
days  later  of  puerperal  fever.  The  prisoner  was  acquitted  on 
the  charge  of  murder,  as  there  was  no  necessary  connection 
between  the  wound  and  the  puerperal  fever.  Acquittals  have 
taken  place  in  cases  of  death  occasioned  by  terror  or  dread  of 
impending  danger  produced  by  acts  of  violence,  as  in  the  case 
of  Reg.  V.  Heany  (Gloucester  Lent  Ass.,  1875).  Here  the  pris- 
oner in  an  altercation  with  his  wife,  who  was  suffering  from 
cancer,  held  up  a  knife  in  a  threatening  'manner,  but  did  not 
touch  her.  This  gave  her  a  shock ;  she  died  two  days  later 
from  fright.  As  there  was  no  distinct  proof  that  death  was 
accelerated  by  this  act,  the  prisoner  was  acquitted  of  the  charge 
of  murder.  Taylor '  found  among  a  large  number  of  cases 
occurring  in  England  during  twenty  years  that  the  latent 
causes  of  death,  as  registered  in  wounded  persons,  were  chiefly 
inflammation  of  the  thoracic  or  abdominal  viscera,  apoplexy, 
diseases  of  the  heart  and  large  blood-vessels,  phthisis,  ruptures 
of  the  stomach  and  bowels  from  disease,  internal  strangulation, 
and  the  rupture  of  deep-seated  abscesses.  Sometimes  the  person 
was  in  good  health  up  to  the  time  of  injur}',  while  in  other  cases 
there  was  merely  a  slight  indisposition.  It  was  only  by  care- 
fulness on  the  part  of  the  medical  experts  that  the  true  cause  of 
death  was  ascertained. 

Again,  it  may  be  claimed  that  death  was  not  necessaril}' 
the  result  of  the  wound  and  was  avoidable  by  good  medical 
TREATMENT.  There  are  many  cases  of  wounds  not  mortal  with 
proper  and  skilled  treatment  which  might  become  so  by  im- 
proper treatment.  They  may  thus  become  directly  mortal  by 
interfering  with  a  source  of  hemorrhage  which  had  been  ar- 
rested, or  secondarily  mortal  by  infection  of  the  wound  by  med- 
» Taylor  :   "  Medical  Jurisprudence, "  11th  Amer.  Ed. ,  1893. 


506  WOUNDS — WOOLSEY. 

dlesome  treatment.  It  would  depend  on  the  medical  witnesses 
to  determine  whether  and  how  far  the  treatment  had  been 
responsible  for  the  fatal  result.  If  the  wound  is  not  of  itself 
mortal  and  it  has  only  become  so  from  improper  treatment, 
this  should  be  a  mitigating  circumstance  in  favor  of  the  ac- 
cused. Medically  speaking,  we  can  seldom  make  the  sharp 
distinction  which  Lord  Hale  did  legally  between  a  wound 
becoming  mortal  from  improper  treatment  and  one  in  which 
improper  treatment  causes  death  irrespective  of  the  wound.  In 
case  of  a  slight  wound  this  distinction  might  be  possible,  but 
not  so  in  case  of  severe  wounds.  Also  there  would  probably 
be  no  conviction,  as  far  as  the  medical  evidence  is  concerned, 
if  the  wound  was  only  mortal  in  consequence  of  improper  treat- 
ment and  not  mortal  as  its  usvial  and  probable  result.  This  may 
naturally  introduce  the  question  of  the  comparative  skill  in 
TREATMENT.  If  death  is  entirely  or  partly  due  to  a  wound  the 
responsibility  of  an  assailant  is  not  altered  by  unskilful  treat- 
ment. The  entire  question  of  the  relation  of  the  wound  to  the 
fatal  result  and  the  effect  on  this  result  of  the  treatment  em- 
plo3^ed  is  left  to  be  determined  by  the  medical  experts,  and 
in  its  solution  great  care  and  judgment  must  be  used.  Al- 
though a  given  fatal  wound  might  not  have  caused  death  under 
the  best  possible  treatment  and  surroundings,  yet,  according  to 
the  above  rule,  the  assailant  is  held  responsible  as  long  as  the 
fatal  result  is  due  partlj^,  at  least,  to  the  wound.  Therefore 
we  see  the  responsibility  of  the  surgeon  not  only  for  the  life  of 
his  patient,  but  also  for  that  of  the  prisoner.  He  should,  there- 
fore, not  deviate  from  the  ordinary  and  most  accepted  practice 
in  such  cases,  as  any  such  deviation  is  taken  hold  of  by  the 
counsel  for  the  defence.  In  fact,  every  point  of  the  treatment 
is  subjected  to  criticism. 

In  a  lacerated  wound  of  the  foot,  if  death  occurs  from 
tetanus,  it  may  be  claimed  that  death  would  not  have  occurred 
if  the  foot  had  been  amputated,  or,  if  the  foot  were  amputated 
and  death  followed,  it  may  be  claimed  that  amputation  was 
unnecessary  and  was  the  cause  of  death.  The  surgeon  should, 
therefore,  be  able  to  give  the  best  reasons  for  every  step  of 
treatment. 

Again,  it  may  be  claimed  that  death  was  not  a  necessary 
result  of  the  wound  and  was  avoidable  but  for  imprudence 


DEATH    FOLLOWING    SLIGHT    PERSONAL   INJURIES.  507 

OR  NEGLECT  on  the  part  of  the  wounded  person.  A  man  after 
being  wounded  may  refuse  to  receive  medical  assistance,  or, 
after  receiving  it,  may  disobey  instructions  or  refuse  to  submit 
to  an  operation  proposed.  Thus  with  a  compound  depressed 
fracture  of  the  skull  the  patient  may  either  refuse  to  see  a  sur- 
geon, or  he  may  refuse  to  submit  to  an  operation  proposed,  or 
he  may  with  or  without  operation  disobey  the  instructions  as 
to  diet  and  quiet,  and  eat  or  drink  heavily  and  refuse  to  go  to 
bed.  Such  a  case  we  can  readily  imagine  might  die  of  menin- 
gitis, etc. 

If  the  symptoms  of  a  wound  are  unfavorable  from  the  start, 
or  if  the  wound  of  itself  is  likely  to  prove  mortal,  the  responsi- 
bility of  the  assailant  is  unmitigated  by  imprudence  or  neglect " 
of  medical  assistance  by  the  wounded  person.  This  is  not 
allowed  as  mitigatorj-,  as  a  sane  man  is  a  free  agent  and  is  not 
obliged  to  call  in  or  submit  to  medical  treatment.  Moreover,  a 
medical  witness  in  many  cases  could  not  swear  that  an  opera- 
tion or  other  plan  of  treatment  would  certainly  save  life.  Thus 
an  amputation  of  the  leg  for  wound  of  the  foot  causing  tetanus 
is  by  no  means  a  certain  means  of  cure.  But  we  can  readily 
imagine  a  case  where  the  refusal  to  submit  to  the  treatment 
proposed  might  be  an  important  element  in  causing  death. 
Thus  in  a  compound  depressed  fracture  of  the  skull  with  com- 
pression, the  medical  witnesses  would  agree  that  the  operation 
would  in  all  probability  save  life.  This  fact  would  probably 
be  only  mitigatory  in  diminishing  the  penalty,  and,  as  stated 
above,  would  not  secure  acqviittal.  But  it  is  none  the  less  im- 
portant for  the  medical  witness  to  bear  these  facts  in  mind  and 
bring  out  the  fa,cts  and  conclusions  clearly  in  his  testimony. 

Death  Following  Slight  Personal  Injuries. — Here 
again  the  claim  might  apparently  be  justified  that  death  was  not 
necessarily  due  to  the  trifling  injury.  And  in  reality  there  is 
commonly  some  unhealthy  state  of  the  body  to  explain  such  an 
unexpected  result.  When  the  disease  accounting  for  this  un- 
healthy state  of  the  body  is  in  some  other  part  than  the  injury, 
an  examination  with  ordinary  care  will  explain  the  case.  But 
if  the  disease  and  injury  are  located  in  the  same  part,  especially 
in  the  head,  the  case  is  more  perplexing,  but  may  be  cleared  up 
by  careful  and  thorough  examination.  Also  the  usual  results 
of  such  an  injury  should  be  considered,  and  whether  the  disease 


508  WOUNDS — WOOLSEY. 

would  be  a  usual  result  of  the  injury,  or  whether  the  sum  total 
of  the  pathological  conditions  found  would  be  accounted  for  by 
the  violence.  It  shovild  be  remembered  that  the  presence  of 
chronic  disease  is  no  excuse.  Thus  Taylor '  cites  the  case  of 
Reg.  V.  Haj^ley  (Lewes  Aut.  Ass.,  18G0),  where  a  boy  with 
chronic  disease  of  the  brain  suffered  from  no  unusual  s3'mptom 
until  he  received  a  severe  flogging,  which  was  followed  by 
death  in  less  than  three  hours.  The  same  author  mentions  also 
the  following  case  to  show  that  fatal  results  may  follow  very 
slight  and  trivial  blows.  Annan  ^  tells  of  a  healthy  four- year- 
old  girl  who  received  a  slight  blow  from  the  shaft  of  a  wheel- 
barrow on  the  skin  about  three  inches  below  the  knee.  There 
was  even  no  external  mark  of  violence,  and  the  injury  was 
thought  to  be  so  slight  as  not  to  require  treatment.  There 
was  pain,  however,  which  increased  on  the  following  day, 
marked  constitutional  symptoms  appeared,  and  the  child  died 
on  the  fourth  day.  Even  to  the  punishment  inflicted  by  school- 
masters death  has  been  imputed. 

When  DEATH  occurs  from  wounds  after  long  periods 
the  injury  may  be  admitted,  but  it  may  be  claimed  that  death  was 
not  necessarily  due  to  the  wound.  Medically  speaking,  death 
is  just  as  much  the  result  of  the  injury  as  if  it  occurred  on  the 
spot.  Of  course,  death  must  be  clearly  traceable  to  the  usual 
and  probable  results  of  the  injury,  and  not  be  dependent  on  any 
other  cause.  An  examination  of  the  wounded  part  and  of  the 
whole  body  will  enable  the  medical  witness  to  determine  the 
cause  of  death  and  whether  it  is  clearly  traceable  to  the  injury. 
A  doubt  on  this  point  may  lead  to  acquittal.  Certain  forms  of 
wounds  or  wounds  in  certain  localities  are  especially  liable  to 
end  fatally  after  a  long  delay,  but  as  the  direct  result  of  the 
wound.  These  are  wounds  of  the  head  and  of  the  spine.  As 
to  the  first  class,  the  injured  person  may  apparently  recover 
and  be  doing  well,  when  he  maj-  suddenly  die  from  a  cerebral 
abscess,  for  instance.  This  is  the  result  of  the  injury,  but  re- 
mains a  longer  or  shorter  time  latent.  In  wounds  of  the  spine 
the  patient  is  generally  paralyzed  below  the  point  of  fracture, 
but  is  apparently  in  good  health.  In  a  longer  or  shorter  time 
he  may  die  of  a  pneumonia,  cystitis,  or  bedsores,  which  are  the 

'  Taylor :  "  Medical  Jurisprudence, "        ^  Med.  Times,  1854,  ii. ,  p.  238. 
llthAmer.  Ed.,  1893. 


WAS  A  WOUND  THE  CAUSE  OF  DEATH  SECONDARILY?      501> 

known  and  regular  consequences  of  the  injury  or  injured  con- 
dition. Astley  Cooper  cites  the  case  of  a  man  who  was  in- 
jured on  the  head  and  died  two  years  later  from  the  effects  of 
the  injury,  as  was  clearly  made  out  by  the  continuance  of  brain 
symptoms  during  the  entire  period.  An  interval  of  eleven 
years  occurred  in  another  head  injury  between  the  injury  and 
the  fatal  result.  The  first  result  of  the  injury  was  concussion 
of  the  brain,  and  the  case  is  mentioned  by  Hoffbauer. '  This 
long  interval  is  unusual.  There  is  a  rule  in  English  law  by 
which  the  assailant  cannot  be  indicted  for  murder  if  the  victim 
of  the  assault  lives  a  year  and  a  day.  Practically  this  makes 
little  difference,  as  nearly  all  cases  would  die  within  that  time; 
but  the  principle  is  wrong  as  looked  at  from  the  medical  stand- 
point. The  protracted  cases  concern,  as  above  stated,  mostly 
injuries  of  the  head,  spine,  and  chest,  among  which  there  are 
some  cases,  like  the  examples  cited,  where,  according  to  Eng- 
lish law,  justice  would  fail  to  be  done. 

III.  Was  a  Wound  the  Cause  of  Death  Secondarily? 

A  wound  is  secondarily  the  cause  of  death  when  the  victim, 
having  recovered  from  the  first  ill  effects,  dies  from  some  wound 
disease  or  accident  or  from  a  surgical  operation  rendered  nec- 
essary in  the  proper  treatment  of  the  wound.  There  may  be 
much  difficulty  in  establishing  the  proof  of  death  from  a  wound 
]jy  means  of  secondary  causes,  for,  1st,  the  secondary  cause 
must  be  in  the  natural  course  of  things ;  and,  2d,  there  must  be 
no  other  accidental  circumstances  to  occasion  the  secondary 
cause. 

The  secondary  cause  may  be  partly  due  to  the  constitution 
of  the  deceased  from  habits  of  dissipation,  which  fact  would 
serve  as  an  expiatory  circumstance  in  the  case.  Among  the 
secondary  causes  of  death  may  be  mentioned  septicaemia,  pya?- 
mia,  erysipelas,  tetanus,  gangrene,  that  is,  wound  diseases,  also 
the  wound  accident — as  we  may  call  delirium  tremens,  and  sur- 
gical operations  rendered  necessary  to  the  treatment  of  the  case. 
We  may  add,  besides  the  regular  wound  diseases,  inflammation 
in  and  about  the  wound,  septic  in  character,  perhaps  not  justi- 
fying the  title  of  septicaemia,  but  which,  with  its  accompanying 
fever,  may  be  the  "  last  straw"  in  a  case  which  might  otherwise 
1 "  Ueber  die  Kopf- Verletzungen, "  1842,  p.  57. 


510  WOUNDS — WOOLSEY. 

recover.     Some  of  these  secondary  causes  will  now  be  considered 
more  at  length. 

Septicemia  is  a  general  febrile  disease  due  to  the  absorp- 
tion into  the  system  from  a  wound  of  the  products  of  bacteria 
or  due  to  the  introduction  into  the  blood  and  tissues  of  the  bac- 
teria themselves.  Depending  on  the  two  sources  of  origin,  we 
have  two  forms  of  septicaemia :  1.  Septic  intoxication  or  sapre- 
mia,  due  to  the  absorption  of  a  chemical  poison,  ptomaines,  and 
often  readily  influenced  and  cured  by  the  removal  of  the  source 
of  these  ptomaines  in  decomposing  blood-clots,  secretions,  etc. 
2.  Septic  infection  comes  on  less  rapidly  but  is  more  serious 
than  the  former  is,  if  properly  and  quickly  treated,  because  the 
source  of  the  trouble  cannot  be  removed,  but  is  in  the  blood  and 
the  tissues.  The  latter  form  is  the  more  common  one  in  wounds, 
though  the  former  may  occur  in  abdominal  wounds,  especially 
when  a  blood-clot  is  present.  The  first  form  begins  acutely,  the 
second  form  more  gradually.  The  infection  in  septicaemia 
takes  place  through  a  wound  and  may  be  due  to  the  weapon 
which  caused  the  wound,  the  unclean  condition  of  the  parts 
wounded,  or  to  the  subsequent  treatment  or  want  of  treatment. 
It  may  even  take  place  through  the  intestinal  mucous  mem- 
brane as  in  cases  of  tyrotoxicon  poisoning.  It  is  most  likely  to 
occur  during  the  first  four  or  five  days  before  the  surfaces  of 
the  wound  granulate,  and  it  consists  in  the  introduction  of  bac- 
teria, especially  staphylococci  and  streptococci.  The  disease  is 
characterized  by  severe  constitutional  symptoms,  acute  contin- 
uous fever,  inflammation  of  certain  viscera  and  of  the  wound, 
and  nervous  disorders.  A  pronounced  chill  ushering  in  the 
fever  is  generally  absent.  Prostration  is  especially  marked,  the 
patient  finally  passing  into  a  typhoid  condition  indifferent  to 
surroundings.  Anorexia  and  headache  are  usually  present; 
diarrhoea  is  common,  vomiting  is  not.  The  skin  is  pale  and 
dusky,  but  not  commonly  icteric ;  at  first  it  is  hot  and  drj^,  later 
moist  and  finally  cold  and  clammy.  The  spleen  is  often  en- 
larged. The  pulse  becomes  weak  and  rapid  and  delirium  is 
followed  by  coma.  The  prognosis  is  grave.  Antiseptic  treat- 
ment generally  prevents  and  often  cures  the  disease,  as  is  the 
case  with  many  other  of  the  wound  diseases ;  hence  the  failure 
to  employ  it  may  be  alleged  by  the  defence  in  mitigation  of  the 
responsibility  of  the  assailant  for  the  fatal  result. 


SEPTICAEMIA — PYEMIA — ERYSIPELAS.  511 

Pyemia  is  closely  allied  to  septicaemia.  It  is  due  to  the 
setting  free  of  bacterial  emboli  or  septic  emboli  from  a  broken- 
down,  septic  thrombus  in  the  neighborhood  of  the  wound,  and 
the  circulation  of  these  emboli  in  the  blood  until  they  are  ar- 
rested and  form  the  characteristic  metastatic  abscesses,  espe- 
cially in  the  lungs,  joints,  abdominal  viscera,  and  parotid  gland. 
Almost  always  the  source  of  infection  is  an  infected  woimd. 
Granulation  does  not  prevent  the  occurrence  of  pyaemia,  which, 
as  a  rule,  commences  at  a  later  stage  than  septicaemia.  It  is 
most  important,  however,  for  our  purpose  to  remember  that 
there  is  such  a  thing  as  spontaneous  pyaemia.  An  injury  not 
causing  a  wound  ma}'  here  be  the  exciting  cause,  but  the  result- 
ing pyaemia  is  an  unexpected  consequence.  A  bruise  of  a  bone, 
for  instance,  by  allowing  bacteria,  which  in  certain  conditions 
may  be  circulating  in  the  blood,  to  find  an  exit  from  the  ves- 
sels into  the  bruised  part,  may  develop  an  acute  osteo-myelitis, 
which  may  be  a  starting-point  of  a  pyaemia.  It  is  but  proper 
to  state,  however,  that  spontaneous  pyaemia  is  a  rare  occurrence. 
In  fact,  it  is  so  rare  that  if  pyaemia  occurs  and  we  find  ever  so 
trifling  an  infected  wound,  we  can  safely  attribute  the  pyaemia 
to  the  wound  and  not  to  a  spontaneous  origin. 

Pyaemia  begins,  as  a  rule,  in  the  second  week  of  the  healing 
process  or  even  later.  It  usually  begins  with  a  chill,  which  may 
be  frequently  repeated.  The  fever  is  very  irregular  and  exacer- 
bations occur  with  each  metastatic  abscess.  The  skin  is  icteric, 
the  icterus  being  hematogenous.  The  pulse  is  rapid  and  be- 
comes weaker.  Infective  endocarditis  may  develop,  which  in- 
creases the  danger  of  metastatic  abscesses,  which  may  then 
occur  in  the  brain.  Otherwise  the  mind  is  clear  and  unaf- 
fected until  the  final  delirium  and  coma.  The  disease  may 
become  chronic,  but  usually  lasts  a  week  or  ten  days.  The 
prognosis  is  very  grave. 

Erysipelas  is  a  still  more  frequent  complication  of  medico- 
legal wounds,  and  though  not  so  fatal  as  the  two  preceding,  it 
is  probably  more  often  the  secondary  cause  of  death  on  account 
of  its  far  greater  frequence.  It  too  is  an  acute  infective  in- 
flammation due  to  the  presence  of  a  micro-organism,  strepto- 
coccus erysipelatis.  This  occurs  mostly  in  the  lymphatics  of 
the  skin,  and  effects  an  entrance  through  some  wound  or  abra- 
sion of  the  skin  or  mucous  membrane,  which  may  be  almost 


512  WOUNDS — WOOLSEY. 

microscopic  in  size.  Probably  there  is  no  such  thing  as  trne 
spontaneous  erysipelas^  though  the  wound  may  be  often 
overlooked  and  only  visible  on  the  closest  examination.  If  a 
wound  has  been  inflicted,  the  size  and  severity  of  it  cannot  be 
alleged  as  a  reason  why  it  was  not  the  starting-point  of  an 
erysipelas.  The  erj^sipelas  must  be  clearly  traced  to  the  injury. 
That  is,  it  must  occur  before  recovery  from  the  wound  or  not 
later  than  a  week  after  it  has  healed,  for  the  incubation  is  prob- 
ably not  longer  than  this.  It  is  difficult  to  connect  an  erysip- 
elas with  a  wound  if  it  occurs  some  time  after  it  has  healed  or 
if  it  occurs  at  a  different  place  and  not  about  the  wound. 
Wounds  of  certain  regions,  as,  for  instance,  scalp  wounds,  are 
especially  liable  to  develop  erysipelas,  but  this  is  probably  owing 
to  the  imperfect  antiseptic  treatment  or  delay  in  applying  it. 
Certain  individuals  are  more  prone  to  it  than  others;  thus  it 
has  been  stated  that  blondes  and  those  suffering  from  Bright's 
disease  are  more  susceptible,  though  how  true  this  is  it  is  hard 
to  say.  It  is  also  probably  more  prevalent  at  certain  times  of 
the  year,  particularly  in  the  spring.  A  wound  after  it  has 
scabbed  over  or  has  begun  to  granulate,  that  is,  after  the  first 
four  or  five  days,  is  very  much  less  apt  to  serve  as  the  avenue 
for  infection.  Erysipelas  usually''  begins  with  a  chill,  or  a  con- 
vulsion in  children.  Nausea  and  vomiting  are  the  rule.  The 
fever  is  remittent  and  ranges  from  102°  to  104°  F. ,  and  the  tem- 
perature may  be  subnormal  when  the  inflammation  is  subsid- 
ing. Prostration  is  marked  and  the  pulse  more  or  less  weak. 
There  may  be  delirium  while  the  fever  is  high.  Locally  there 
is  rarely  anything  characteristic  until  twent^'-fonr  hours  or  so 
after  the  chill.  Then  we  have  a  reddish  blush  with  some  ten- 
sion, burning  and  itching  of  the  skin.  At  first  the  redness  is 
most  marked  about  the  wound,  later  at  the  edge  of  the  advanc- 
ing, serpentine  margin.  It  spreads  widely  and  rapid]}",  and 
after  three  or  four  days  the  part  first  attacked  begins  to  im- 
prove. Desquamation  follows.  The  duration  may  be  a  week 
or  ten  daj^s  or  as  long  as  a  month.  The  inflammation  may  be 
much  more  severe,  involving  the  subcutaneous  connective  tissue 
in  phlegmonous  erysipelas. 

Facial  erysipelas  is  a  common  variety  and  was  once  re- 
garded as  idiopathic,  but  a  wound  on  the  skin  or  mucous  mem- 
brane is  probably  always  present.     The  prognosis  of  erysipelas 


FACIAL  ERYSIPELAS — TETANUS.  513 

is  usually  favorable.  Since  the  use  of  antiseptics  it  is  far  less 
common  than  formerly,  though  still  the  most  common  of  the 
infective  wound  diseases. 

If  a  man  wounded  in  an  assault  is  taken  to  a  hospital  where 
erysipelas  prevails,  the  question  of  responsibility  arises,  for, 
medically  speaking,  he  is  subjected  to  great  and  avoidable 
risks. 

Tetanus  is  an  infective  bacterial  disease  affecting  chiefly  the 
central  nervous  system  and  almost  always,  if  not  always,  origi- 
nating from  a  wound.  Tetanus,  like  erysipelas,  is  probably 
always  traumatic  and  never  •  strictly  idiopathic.  The  wound 
may  be  so  slight  as  to  escape  notice.  When  it  follows  such  in- 
juries as  simple  fracture  internal  infection  probably  occurs, 
though  such  cases  are  extremely  rare.  It  is  said  that  the 
weather  influences  the  development  of  tetanus,  and  that  it  is 
more  common  in  the  tropics.  There  are  also  certain  sections 
where  tetanus  is  much  more  common  than  elsewhere  and  where 
it  may  be  said  to  be  almost  endemic.  Punctured  wounds  are 
most  likely  to  be  followed  by  tetanus,  for  they  offer  the  best 
opportunity  for  the  development  of  the  bacteria,  which  are  an- 
aerobic. Wounds  in  dirty  parts  of  the  body,  like  the  hands 
and  feet,  are  more  apt  to  be  followed  by  tetanus  than  those 
elsewhere.  Tetanus  usually  appears  about  the  end  of  the  first 
week  after  a  wound  has  been  received,  but  it  may  not  appear 
for  a  longer  period,  even  three  or  four  weeks,  so  that  the  wound 
may  have  been  some  time  healed.  To  connect  tetanus  with  a 
particular  wound,  note  (1)  if  there  were  any  symptoms  of  it 
before  the  wound  or  injury,  (2)  whether  any  other  cause  inter- 
vened after  the  wound  or  injury  which  would  be  likely  to 
produce  it,  and  (3)  whether  the  deceased  ever  rallied  from  the 
effects  of  the  injury.  Tetanus  comes  on  suddenly  without 
warning.  The  injured  person  first  notices  that  he  cannot  fully 
open  the  mouth,  he  has  lock-jaw,  and  the  back  of  the  neck  is 
stiff.  The  muscles  of  the  abdomen  and  back  are  next  involved 
so  that  the  back  is  arched  in  the  position  known  as  opisthot- 
onos^ and  the  abdomen  presents  a  board-like  hardness.  The 
muscles  of  the  fauces,  pharynx,  and  diaphragm  maj^  next  be- 
come involved,  causing  difficulty  in  swallowing  and  breathing. 
The  thighs  may  or  may  not  be  involved,  but  the  arms  and  legs 
almost  never.  Owing  to  the  spasm  of  the  abdominal  muscles, 
33 


514  WOUNDS — WOOLSEY. 

micturition  and  defecation  are  difficult  and  respiration  is  hin- 
dered. The  muscles  are  in  the  condition  of  tonic  spasm  which 
permits  the  patient  no  rest,  the  face  bears  the  "  risus  sardon- 
icus, "  and  the  suffering  is  extreme.  If  the  patient  lives  more 
than  two  or  three  daj's  the  tonic  spasm  partly  gives  way  to 
increased  reflex  irritability,  in  which  a  noise,  jar,  or  draught  of 
air  may  give  rise  to  clonic  and  tonic  spasms  in  the  muscles 
affected.  The  patient  may  die  at  such  times  from  tonic  spasm 
of  the  respiratory  muscles,  or  he  may  die  of  prostration  from 
want  of  food  and  sleep,  worn  out  by  the  suffering  and  muscular 
spasm.  The  mind  is  usually  clear  to  the  last.  Fever  is  not 
characteristic  of  the  disease.  Tetanus  may  be  rapidly  fatal ;  in 
two  or  three  days,  or  it  may  be  or  become  more  chronic.  The 
prognosis  of  acute  tetanus  is  almost  invariably  fatal;  that  of 
chronic  tetanus  is  grave,  but  a  certain  proportion  of  cases 
recover. 

Diagnosis. — This  is  easy.  It  differs  from  a  true  neuritis 
in  the  peripheral  nerves  in  that  no  matter  where  the  wound  is  sit- 
uated the  first  symptom  is  in  the  muscles  of  the  jaw  and  the 
back  of  the  neck,  and  not  at  the  site  of  the  injury  and  distally 
from  this  point.  Trismus  is  applied  to  a  milder  form  of  the 
disease  in  which  only  the  face  and  neck  muscles  are  involved 
and  "  lock-jaw"  is  a  prominent  symptom.  Some  cases  of  tetany 
may  be  mistaken  for  so-called  spontaneous  tetanus.  Tetany 
may  follow  child-bed,  fevers,  mental  shocks,  exposure  to  cold 
and  wet,  extirpation  of  goitre,  intestinal  irritation,  etc.  It 
consists  of  painful  tonic  spasms  of  the  muscles  of  the  arms  and 
feet.  The  attacks  last  one-half  to  two  hours  or  more,  and  may 
be  preceded  by  a  dragging  pain.  They  may  be  brought  on  by 
pressure  on  the  nerve  leading  to  the  muscles  affected.  Striking 
the  facial  nerve  often  causes  contraction  of  the  face  muscles. 
There  is  no  trismus  but  there  may  be  opisthotonos.  The  patient 
seems  well  between  the  attacks  and  most  cases  recover  without 
treatment. 

Delirium  tremens  may  occur  as  a  secondary  consequence 
of  injuries,  or  necessary  surgical  operations  in  the  case  of  those 
who  are  habitually  intemperate.  Those  who  habitually  use 
opium,  tobacco,  cannabis  indica,  or  even  tea  or  coffee  to  excess 
are  said  to  be  subject  to  it.  It  may,  therefore,  be  justly  alleged 
that  death  is  avoidable  in  very  many  cases,  but  for  an  abnormal 


DEATH   FROM    SURGICAL   OPERATIONS.  515 

and  unhealthy  state  of  the  body.  The  disease  is  characterized 
by  delirium,  a  peculiar  tremor  of  the  muscles,  insomnia,  and 
anorexia.  Pneumonia  may  complicate  the  case.  The  patients 
die  in  fatal  cases  from  exhaustion  due  to  insomnia,  lack  of 
nourishment,  and  their  constant  activity  of  body  and  mind. 
The  prognosis  is  usually  favorable,  taking  all  cases  together, 
but  in  delirium  tremens  secondary  to  surgical  injuries  or  oper- 
ations the  prognosis  is  serious. 

Death  from  surgical  operations  performed  for  the 
treatment  of  wounds.  The  operation  is  a  part  of  the  treatment, 
and  if  it  is  done  with  ordinary  care  and  skill  the  accused  is 
responsible  for  the  result.  The  necessity  and  mode  of  operation 
must  be  left  to  the  operator's  judgment.  As  the  defence  may 
turn  on  the  necessity  for  and  the  skilful  performance  of  the  opera- 
tion, it  is  well  to  wait  for  the  advice  and  assistance  of  others  if 
practicable,  for  death  is  not  unusual  from  severe  operations. 
The  patient  may  die  on  the  operating-table  after  losing  little 
blood,  from  fear,  pain,  or  shock.  Or  he  ma}^  die  from  second- 
ary hemorrhage  or  any  of  the  secondary  causes  of  death  from 
wounds  enumerated  above.  The  evidence  of  the  necessity  of 
the  operation  must,  therefore,  be  presented  by  the  operator.  If 
an  operation  is  necessary  and  not  performed,  the  defence  might 
allege  that  death  was  due  to  the  neglect  of  the  surgeon.  An- 
other question  for  the  medical  witnesses  to  determine  is  whether 
the  operation  was  rendered  necessary  because  of  improper  pre- 
vious treatment,  for  if  it  was  the  responsibility  of  the  assailant 
may  be  influenced.  The  meaning  of  the  term  "  necessity"  is 
here  a  matter  of  importance.  Unless  an  operation  is  necessary 
to  the  preservation  of  life,  if  death  occurs  there  is  some  doubt 
whether  the  assailant  is  responsible.  But,  medically  speaking, 
we  would  not  hesitate  to  urge  an  operation  on  a  wounded  man  in 
order  to  preserve  function,  or  even  to  save  deformit}-  as  well 
as  to  save  life.  In  the  case  of  operations  done  under  a  mistaken 
opinion,  neither  necessary  to  save  life  nor,  as  the  result  proves, 
to  save  function  or  guard  against  deformity,  if  death  follows 
the  assailant  may  be  relieved  from  responsibility.  Thus  an 
aneurism  following  an  injury  might  be  mistaken  for  an  abscess 
and  opened  with  skill  but  with  a  fatal  result.  It  is  also  for  the 
medical  experts  to  determine  whether  an  operation  was  unnec- 
essary or  unskilfuUy  performed,  for  if  it  were  and  death  re- 


51 G  WOUNDS — WOOLSEY. 

suited  from  it,  the  responsibility  of  the  prisoner  is  affected 
unless  the  original  wound  would  be  likely  to  be  fatal  without 
operation.  According  to  Lord  Hale,  if  death  results  from  an 
unskilful  operation  and  not  from  the  wound,  the  prisoner  is 
not  responsible.  But  yet  death  may  occur  as  the  result  of  the 
most  skilful  operation  necessary  to  the  treatment  of  a  wound, 
and  not  be  dependent  at  all  on  the  wound  itseK.  If  the  opera- 
tion is  skilfully  performed,  and  yet  the  patient  dies  from  sec- 
ondarj^  causes,  such  as  those  above  enumerated  or  any  others, 
the  prisoner  is  still  responsible,  and  the  medical  testimony  is 
concerned  with  the  performance  of  the  operation  and  the  sec- 
ondary causes  of  death.  The  relative  skill  of  the  operator  or 
surgeon  i§  probably  not  a  question  for  the  jury  in  criminal 
cases,  on  the  ground  that  the  man  who  inflicts  the  injury  must 
take  all  the  consequences,  good  or  bad.  In  a  civil  suit,  for  in- 
stance an  action  for  malpractice,  the  case  is  otherwise,  and  all 
the  medical  facts  and  opinions  are  submitted  to  the  jury.  The 
law  regards  three  circumstances  in  death  after  surgical  opera- 
tions :  (1)  The  necessity  of  the  operation,  (3)  the  competence  of 
the  operator,  and  (3)  whether  the  wound  would  be  fatal  without 
operation. 

Death  may  occur  from  ancesthetics  used  in  an  operation 
without  any  recognizable  contributing  disease  of  the  patient,  or 
carelessness  or  lack  of  skill  in  the  administration  of  the  anaes- 
thetic. Of  course,  the  question  of  absence  of  contributing  dis- 
ease on  the  part  of  the  patient  and  of  its  proper  administration 
must  be  satisfactorily  answered  in  cases  of  death  from  the  an- 
aesthetic in  an  operation  rendered  necessary  in  the  treatment  of 
a  wound.  Death  from  an  anaesthetic  may  occur  before,  during, 
or  after  an  operation  itself.  Medically  speaking,  the  neces- 
sity of  the  use  of  an  anaesthetic  in  operations  cannot  be  ques- 
tioned, and  in  emergencies  where  an  operation  becomes  neces- 
sary, and  not  a  matter  of  choice,  its  use,  with  special  care,  is 
justifiable  even  with  existing  organic  disease,  which  usually 
contraindicates  it.  As  death  may  be  alleged  to  be  due  to  the 
use  of  a  particular  anaesthetic,  it  is  always  best  in  operating  on 
account  of  an  injury  which  may  require  a  medico-legal  investi- 
gation, to  use  that  anaesthetic  which  is  most  generally  used 
and  indorsed  in  the  particular  section  of  country  in  question. 
Of  course,  it  is  not  lawful  to  operate  against  the  will  of  a  person 


WAS  WOUND  MADE  BY  THE  INSTRUMENT  DESCRIBED?     517 

who  preserves  consciousness  and  will.  It  may  be  added  in  this 
connection  that  if  a  medical  man  be  guilty  of  misconduct,  aris- 
ing either  from  gross  ignorance  or  criminal  inattention,  where- 
by the  patient  dies,  he  is  guilty  of  manslaughter,  according  to 
Lord  Ellenborough.  Omissions  or  errors  in  judgment,  to 
which  all  are  liable,  are  not  criminal. 

IV.  Was  THE  Wound  made  by  the  Instrument  Described? 

It  is  not  often  necessary  to  prove  that  a  weapon  was  used, 
though  it  may  affect  the  punishment.  For  the  use  of  a  weapon 
implies  malice  and  intention  and  a  greater  desire  to  do  injury. 
The  prisoner  may  swear  that  no  weapon  was  used  when  the 
nature  of  the  wound  clearly  proves  that  one  was  used.  The 
explanation  of  the  prisoner  of  the  origin  of  the  wound  may  thus 
be  discredited.  We  cannot  often  swear  that  a  particular  weapon 
was  used,  but  only  that  the  wound  was  made  by  one  similar  to 
it  in  shape  and  size.  Thus  Schworer  tells  of  the  case  of  a  man 
stabbed  in  the  face  by  another.  The  medical  witness  testified 
that  the  wound  was  caused  by  a  knife  shown  at  the  trial  which 
had  a  whole  blade,  but  a  year  later  the  point  of  the  knife  which 
had  really  caused  the  wound  was  discharged  from  an  abscess 
in  the  cheek  at  the  site  of  the  wound.  The  surgeon  thus  made 
a  too  definite  statement  in  regard  to  the  knife  shown. 

It  is  often  very  difficult  to  answer  the  above  question.  We 
base  our  opinion  chiefly  on  two  sources:  1st,  and  most  impor- 
tant, by  an  examination  of  the  wound,  and,  2d,  by  an  examina- 
tion of  the  instrument  said  to  have  been  used.  Certain  particu- 
lars of  the  wound  may  furnish  indications  as  to  the  weight, 
form,  and  sharpness  of  the  instrument  used.  There  are  certain 
wounds  which  must  have  been  made  by  an  instrument,  namely, 
incised  and  punctured  wounds.  The  above  question  is  deter- 
mined more  or  less  by  what  has  been  said  in  a  former  section 
on  wounds,  but  we  will  now  consider  what  special  features  of 
these  and  other  classes  of  wounds  indicate  the  nature,  shape, 
size,  etc.,  of  the  weapon  used. 

Incised  wounds  must  be  made  by  a  cutting  instrument. 
We  would  here  exclude  those  contused  wounds  of  the  scolp  and 
eyebrows  which  closely  resemble  incised  wounds,  but  we  have 
already  seen  that  we  can  diagnose  between  these  wounds  and 


518  WOUNDS — WOOLSEY. 

incised  wounds  by  careful  inspection.  But  the  locality  should 
put  us  on  our  guard,  so  that  in  case  of  wounds  of  these  two 
regions  we  should  be  especially  careful  in  making  the  exami- 
nation. 

In  the  case  of  incised  wounds  we  cannot  often  tell  the  shape 
or  size  of  the  weapon,  but  we  are  able  to  tell  certain  character- 
istics about  it.  The  sharpness  of  the  instrument  may  be  in- 
ferred from  the  clean  and  regular  edges.  The  depth  of  the 
wound  may  also  indicate  the  sharpness  of  the  weapon.  A  long 
"  tail"  in  the  wound  indicates  that  the  weapon  was  sharp  as  well 
as  that  this  was  the  part  of  the  wound  last  made.  If  the  edges 
of  the  wound  are  rough,  we  may  infer  that  the  edges  of  the 
weapon  were  rough  and  irregular.  Wounds  caused  by  bits  of 
china  or  glass  or  fragments  of  bottles,  besides  having  rough 
and  lacerated  edges,  are  characterized  by  an  irregular  or  angu- 
lar course  in  the  skin. 

Some  cutting  weapons,  like  an  axe,  act  as  much  by  means 
of  their  weight  as  by  their  cutting  edges.  Wounds  caused  by 
such  weapons  we  can  often  distinguish  by  the  following  signs : 
The  edges  are  not  as  smooth  as  is  the  case  with  a  cutting  instru- 
ment, and  they  may  be  more  or  less  lacerated  and  show  signs 
of  contusion.  The  wound  is  often  deep  in  comparison  with 
its  length,  and  the  ends  of  the  wound  abrupt  instead  of  slanting 
up  from  the  bottom  to  the  surface.  The  section  of  resisting 
organs  and  the  impression  of  the  edge  of  the  weapon  on  the 
bone  are  further  signs  of  the  use  of  such  a  weapon. 

The  form  and  direction  of  a  wound  may  possibly  give  some 
indication  of  the  form  of  the  instrument — -for  instance,  whether 
it  be  straight  or  curved  like  a  pruning-knife,  as  in  the  case  cited 
by  Vibert '  of  a  wound  of  the  neck  which  suddenly  became 
deeper  toward  its  extremity  and  changed  its  direction;  the 
whole  being  explained  on  the  supposition  that  it  was  made  by 
a  pruning-knife. 

But  it  is  in  punctured  wounds  especially  that  we  are  en- 
abled most  often  and  most  accurately  to  determine  the  kind  of 
a  weapon  used.  Here  from  the  form  of  the  wovmd  we  may 
judge  of  the  form  and  size  of  the  weapon.  In  speaking  of 
punctured  wounds  in  a  former  section  we  divided  them  into 
four  groups,  reference  to  which  may  here  be  made.  In  the  first 
■"Precis  de  Medeciue  Legale,"  2d  Ed.,  1S90,  p.  203. 


PUNCTURED   WOUNDS,  519 

group,  or  those  caused  by  cylindrical  or  conical  weapons,  when 
tlie  Aveapon  is  very  fine  it  may  leave  no  track  at  all;  if  a  little 
larger,  we  may  infer  from  a  linear  bloody  track  that  the  weapon 
was  needle-like  in  shape.  The  length  of  the  instrument  or  the 
depth  to  which  it  penetrated  may  be  found,  as  a  rule,  only  by 
dissection.  If  the  weapon  were  larger  and  conical,  we  have 
seen  that  the  wounds  would  be  linear  with  two  angles,  the 
length  of  the  wound  being  parallel  to  the  direction  of  the  fibres 
in  the  skin. 

Here  we  may  judge  of  the  form  of  the  weapon  from  the 
following  circumstances:  From  a  comparison  of  the  depth 
with  the  size  of  the  opening,  we  know  that  it  was  a  punctured 
wound.  The  edges  and  angles  are  not  smooth  and  even  enough 
for  a  stab-wound  with  a  knife,  for  the  edges  are  torn  and  not 
cut,  and  a  stab- wound  would  be  the  only  form  of  wound  with 
which  we  would  be  likely  to  confuse  it.  Furthermore,  the  di- 
rection of  the  long  axis  of  the  wound  parallel  to  that  of  the  skin 
fibres  in  the  region  in  which  it  occurs  and  the  very  slight  re- 
traction of  the  edges  distinguish  it  from  a  stab-wound.  By 
these  signs  we  can  almost  alwaj^s  distinguish  such  wounds 
from  stab- wounds,  and  thus  tell  the  form  of  the  weapon  used. 
As  to  the  size  of  weapon  used,  these  wounds  if  of  any  size 
are  generally  smaller  than  the  weap6n,  for  the  skin  is  put  on 
the  stretch  by  the  weapon  and  yields  to  a  certain  extent. 
The  actual  wound,  therefore,  is  smaller  in  circumference  than 
the  weapon.  The  size  of  the  wound  is  smaller  than  that  part 
of  the  weapon  occupying  the  wound  when  the  weapon  was 
arrested;  it  may  be  very  much  smaller  than  the  weapon  at  its 
largest  point.  Small  wounds  of  this  kind  are  generally  larger 
than  the  instrument  producing  them. 

The  second  group  of  punctured  wounds,  or  stab-ivounds,  are 
by  far  the  most  common  and,  therefore,  the  most  important 
variety  of  punctured  wounds.  If  the  stab- wound  is  perpen- 
dicular  to  the  surface  the  fotnn  of  the  wound  may  represent 
pretty  closely  that  of  the  weapon  at  the  point  where  the  latter 
was  arrested,  wb ether  it  has  a  single  or  double  cutting  edge. 
But  even  here  there  are  exceptions.  Frequently  a  weapon 
with  a  broad  back  and  only  one  cutting  edge  may  produce  a 
wound  resembling  that  of  an  instrument  with  two  cutting 
edges,  the  second  angle  tearing  as  in  the  former  class.     Here 


520  WOUNDS — WOOLSEY. 

on  close  examination  we  can  sometimes  distinguish  the  differ- 
ence between  the  two  angles,  and  judge  correctly  of  the  shape 
of  the  weapon.  In  fact,  wounds  made  by  common  pocket- 
knives  are  regularly  slit-like  and  not  wedge-shaped,  as  the 
wound  is  caused  only  by  the  cutting  edge  of  the  knife.  Again, 
if  the  single  cutting  edge  is  blunt,  in  rare  cases  the  wound  is 
produced  in  the  same  manner  as  those  of  the  first  group,  or 
conical  and  cylindrical  instruments.  We  would  be  led  to  sup- 
pose that  the  wound  was  produced  by  such  an  instrument,  as 
both  angles  are  torn,  unless  the  direcion  of  the  wound  might 
not  follow  that  of  the  fibres  of  the  skin,  in  which  case  we 
would  be  left  in  doubt.  Stab-wounds  are  sometimes  angular 
from  the  knife  being  withdrawn  in  a  slightly  different  direction 
from  that  in  which  it  was  introduced  or  from  an  unequal 
retraction  of  the  skin  (see  Fig.  9).  If  the  stab-tvound  is 
obliquely  directed,  we  can  still  judge  of  tlie  general  shape  of 
the  weapon,  with  exception  of  the  cases  above  mentioned.  The 
dimensions  and  size  of  the  weapon  are  here  much  harder  to 
determine.  The  di?nensions  of  a  stab-wound  in  the  skin  may 
be  the  same  as  those  of  the  weapon,  or  of  that  part  of  the 
weapon  which  is  arrested  in  the  wound,  but  often  they  are  not 
so.  To  measure  the  size  of  a  wound  exactly  so  as  to  get  at  the 
exact  size  of  the  instrument,  we  should  place  the  region  of  the 
wound  in  the  same  position,  etc.,  that  it  was  when  the  wound 
was  inflicted,  and  this  we  cannot  often  do.  As  the  skin  was 
tense  or  relaxed  at  the  time  the  wound  was  inflicted,  so  the 
wound  in  the  skin  appears  smaller  or  larger,  just  as  with  a 
sheet  of  rubber  under  similar  conditions.  If  the  instrument  is 
very  blunt,  the  wound  in  the  skin  may  be  smaller  than  the 
weapon  whether  the  skin  near  the  wound  is  tense  or  not.  Thus 
Hofmann  saw  the  wound  from  a  blunt  bayonet  one  centimetre 
shorter  than  the  weapon. 

The  wound  of  the  skin  may  be  shorter  and  broader  than  the 
weapon  used  on  account  of  retraction  of  the  edges  of  the  wound, 
and  this  is  especially  marked  when  the  wound  lies  transversely 
to  the  direction  of  the  skin  fibres.  On  the  other  hand,  the 
length  of  the  external  wound  is  more  often  greater  than  that 
of  the  weapon,  because  the  wound  is  elongated  by  making  pres- 
sure toward  the  cutting  edge  on  withdrawal  of  the  weapon,  and 
an  oblique  wound  measures  longer  than  the  weapon.     If  the 


PUNCTURED   WOUNDS. 


521 


blow  is  from  above  downward  and  the  cutting  edge  of  the 
Aveapon  is  uppermost,  the  length  of  the  wound  is  not  so  likely 
to  be  increased  much  beyond  the  measurement  of  the  weapon 
as  when  the  cutting  edge  is  directed  downward.  There  is  but 
one  condition  in  which  a  stab-wound  is  at  all  likely  to  corre- 
spond in  dimensions  with  that  of  the  weapon,  and  that  is  when 
the  wound  is  perpendicular  to  the  surface.  Even  here  the 
wound  may  be  lengthened  on  withdrawal  of  the  weapon,  and 
we  have  to  allow  for  retraction  of  the  edges  and  try  to  put  the 


i 


^  -"-^/Z^ 


Fig.  9.— Angular  Stab- Wounds  of  the  Anterior  CliestWall  caused  by  a  Strong  Pocket-Knife. 


parts  in  the  same  condition  of  tension  or  laxity  as  at  the  time 
of  wounding.  Even  in  the  most  favorable  case,  therefore,  we 
cannot  with  certainty  tell  the  exact  size  of  the  weapon.  If  a 
stab- wound  be  directed  obliquely  to  the  surface,  then  the  length 
of  the  wound  is  greater  than  that  of  the  weapon,  unless  this  in- 
crease be  exactly  counterbalanced  by  the  lateral  retraction  of 
the  wound.  The  size  of  the  weapon  in  such  oblique  wounds  is 
further  obscured  by  the  changes  of  size  duo  to  withdrawal  of 
the  weapon,  retraction  of  the  edges,  and  the  condition  of  the 
tension  of  the  skin  at  the  time  the  wound  was  inflicted. 

Dupuytren  remarks  that  stab- wounds  are  smaller  than  the 
weapon  owing  to  the  elasticity  of  the  skin,  but  a  lateral  motion 
of   the  weapon   may   cause   considerable  enlargement   of  the 


523  WOUNDS — WOOLSEY. 

wound.     If  a  stab-wound  has  traversed  a  part  of  the  body,  the 
wound  of  exit  is  smaller  than  that  of  entrance. 

The  depth  of  a  punctured  wound  may  be  any  part  of  the 
length  of  the  weapon,  or  it  may  even  be  deeper  than  the 
length  of  the  weapon  owing  to  a  depression  of  the  surface 
by  the  force  of  the  blow,  or  the  pressure  of  the  handle  of  the 
weapon  or  the  hand  holding  it.  We  have  already  seen  that 
this  may  occur  in  a  marked  degree  in  penetrating  wounds 
of  the  abdomen  involving  one  of  the  movable  viscera,  also 
in  wounds  of  the  thorax,  partly  from  depression  of  the  sur- 
face and  partly  from  an  expansion  of  the  thorax  when 
opened  at  the  autopsy,  thus  increasing  the  measured  depth 
of  the  wound.  Punctured  wounds  of  the  third  class  made  by 
instruments  with  ridges  or  edges,  like  foils,  files,  etc.,  pre- 
sent more  or  less  the  shape  of  the  weapon  if  the  edges  are 
cutting,  but  not  always  so  if  the  direction  of  the  wound  be 
oblique  or  the  parts  unevenly  stretched.  If  the  edges  are  not 
cutting  they  cause  wounds  more  or  less  like  the  first  class  of 
punctured  wounds,  but  we  can  often  distinguish  them  from  the 
latter  by  little  tears  in  the  edges.  The  entrance  and  exit 
wounds  may  not  be  alike. 

Wounds  made  by  bits  of  glass  and  earthenivare  have  irreg- 
ular and  uneven  edges.  Taylor '  relates  a  case,  Reg.  v.  Ankers 
(Warwick  Lent  Ass.,  18-i5),  where  the  wound  was  attributed 
to  a  fall  on  some  broken  crockery,  but  the  wound  was  cleanly 
incised  and  the  prisoner  was  convicted.  As  it  may  be  alleged 
in  defence  that  a  given  wound  was  caused  by  a  fall  on  broken 
Crocker}"  or  other  substances  capable  of  producing  a  punctured 
wound,  it  is  important  to  notice  whether  the  edges  are  lacerated 
and  irregular  or  smooth  and  clean.  The  author  quoted  above 
cites  another  case  which  occurred  to  Watson,  where  the  pris- 
oner alleged  that  a  deep,  clean-cut  wound  of  the  genitals  of  a 
woman  which  had  caused  her  death  was  due  to  a  fall  on  some 
broken  glass.  The  character  of  the  wound  disproved  this  de- 
fence. Another  feature  of  such  wounds,  especially  if  they  be 
deep  in  comparison  to  their  length,  is  that  they  are  very  apt  to 
contain  small  particles  of  the  glass  or  earthenware  which  caused 
them.  In  fact,  in  all  wounds  it  is  well  to  search  for  anj'  small 
fragments  which  will  throw  light  upon  the  weapon  used. 
'"JMed.  Jurisprud.,"  11th  Amer.  Ed.,  1892. 

f 


LACERATED   WOUNDS — CONTUSIONS.  523 

Wounds  caused  by  scissors  are  often  of  characteristic  -shape. 
If  the  scissors  were  open  we  find  two  symmetrical,  punctured 
diverging  wounds,  presenting  more  or  less  clearly  the  form  of 
the  blades  of  the  scissors.  If  the  blades  have  been  approx- 
imated there  is  a  triangular  interval  between  the  punctures,  the 
apex  of  which  is  truncated  if  any  skin  remains  between  the 
punctures. 

Lacerated  ivounds  may  not  indicate  the  weapon  used  as 
clearly  as  punctured  wounds,  but  the  agent  which  produced 
them  is  often  indicated  by  the  appearance  of  the  wound.  They 
are  generally  accidental.  But  where  they  occur,  as  they  not  in- 
frequently do,  on  the  bodies  of  new-born  children,  they  may 
give  rise  to  the  charge  of  infanticide.  In  some  cases  the 
weapon  which  caused  the  wound  fits  the  wound  produced,  and 
thus  important  evidence  may  be  furnished  the  prosecution. 
Taylor  '  cites  the  case  of  Montgomery  (Omagh  Sum.  Ass.,  1873), 
where  a  bill-hook  which  fitted  the  injuries  on  the  skull  of  the 
deceased  was  found  buried  in  a  spot  to  which  the  prisoner  was 
seen  to  go.  These  facts  connected  the  prisoner  with  the  weapon 
and  the  weapon  with  the  murder.  In  other  cases  the  wounds 
may  be  so  lacerated  or  contused  that  the  indications  of  the 
weapon  are  obscured. 

Contusions  and  Contused  Wounds. — The  shape  of  a 
contusing  body  is  sometimes  reproduced  by  the  contusion  and 
the  ecchymosis.  Thus  we  are  enabled  to  distinguish  the  marks 
of  a  whip,  the  fingers,  the  fist,  etc.  This  is  best  seen  when 
the  ecchymosis  is  fresh,  for  soon  the  edges  extend  and  the  out- 
line is  less  clearly  marked.  Plaques  parcheminees,  which  we 
have  already  described  as  the  marks  of  contused  erosions,  may 
show  the  form  of  finger-nails,  etc.  Contused  wounds  like  sim- 
ple contusions  may  show  the  shape  of  the  weapon. 

If  the  contusing  body  has  a  large  area,  the  whole  of  this 
area  cannot  often  strike  the  body  at  once,  so  that  the  outline 
of  the  contusion  does  not  represent  that  of  the  weapon.  But  in 
general,  severe  contusions  present  greater  difficulties  than  the 
preceding  classes  of  wounds.  We  must  generally  be  content  if 
we  can  determine  whether  the  wound  was  caused  by  a  weapon, 
including  the  fist,  or  by  a  fall,  and  we  are  often  unable  to  say 
even  this.  A  fall  is  often  alleged  by  the  defence  as  the  cause 
'Taylor,  "Med.  Jurisprud.,"  11th  Amer.  Ed.,  1892. 


624  WOUNDS — WOOLSEY. 

of  the  injury,  but  of  course  if  the  prisoner  was  responsible  for 
the  fall  he  is  responsible  for  the  results  of  the  fall.  If  there 
are  contusions  or  contused  wounds  on  several  parts  of  the 
head,  or  if  the  wounds  are  on  the  vertex  of  the  head,  it  is  pre- 
sumptive of  the  use  of  weapons.  We  cannot  often  swear  that 
each  and  every  wound  on  the  head  was  due  to  the  use  of  a 
weapon.  On  the  other  hand,  the  presence  of  grass,  sand, 
gravel,  etc.,  in  a  wound  is  presumptive  of  a  fall  and  of  the 
origin  of  the  wound  in  this  manner.  In  case  of  a  fall  from  a 
height  the  wound  or  wounds  might  be  in  almost  any  part  of 
the  body,  on  the  vertex  or  elsewhere.  Such  a  fall  may  be  the 
result  of  accident,  suicide,  or  murder.  It  is  not  unusual  for 
female  complainants  to  ascribe  their  wounds  to  a  fall  to  excul- 
pate the  prisoner,  especially  if  this  happens  to  be  her  husband. 
We  should  remember  that  in  the  scalp  or  over  the  eyebrows  a 
contused  wound  caused  by  a  blunt  instrument  may  resemble  an 
incised  wound.  As  already  stated,  however,  if  the  wound  is 
fresh  careful  examination  will  lead  to  a  correct  opinion,  and 
the  use  of  a  sharp  instrument  may  be  disproved.  If  the  wound  is 
not  recent  there  is  great  difficulty  in  judging  of  the  cause.  It 
is  well  to  caution  against  accepting  the  interested  statements 
of  others  in  regard  to  the  use  of  a  weapon,  unless  the  character 
of  the  wound  bears  them  out  very  strongly.  There  may  be  a 
bad  motive  for  imputing  the  use  of  a  certain  weapon  to  the 
assailant.  It  is  far  better  to  rely  solely  upon  the  evidence  fur- 
nished by  the  wound  in  such  cases. 

It  would  be  useful  if  we  could  lay  down  some  general  rules 
to  discriminate  between  wounds  caused  by  the  blow  of  a  weapon 
and  those  caused  by  falls,  but  this  we  are  unable  to  do  so  as  to 
cover  all  cases.     Each  case  must  be  judged  by  itself. 

If  the  question  is  asked  luhich  of  two  iveapons  caused  cer- 
tain contusions  or  contused  wounds,  we  are  still  less  likelj''  to 
be  able  to  answer  it.  In  such  a  case  we  must  make  an  accu- 
rate examination  of  the  form  of  the  wound  and  compare  it 
closely  with  that  of  the  weapon.  In  such  cases  also  the  second 
source  of  information  on  which  we  base  our  opinion  as  to  the 
relation  of  a  weapon  to  tlie  wound  may  be  of  use,  namely,  the 
examination  of  the  weapon.  The  presence  of  blood,  hair,  cot- 
ton or  woollen  fibres  on  one  of  two  weapons  indicates  that  this 
was  the  weapon  used.     The  presence  of  blood  is  particularly  to 


WAS    A   WOUND    SELF-INFLICTED?  525 

be  looked  for,  and  in  those  parts  of  the  weapon  from  which  it 
could  be  washed  off  least  easily.  We  should  further  note  the 
condition  of  the  point  and  edge  of  the  weapon,  and  if  the  edge 
is  broken  or  nicked  at  all,  whether  this  condition  is  old  or 
recent.  The  sharpness  of  the  edge  should  further  be  noted, 
and  if  the  edge  is  sharp  note  whether  it  has  recently  been 
sharpened.  All  these  points  have  a  certain  bearing  on  the  case. 
Also  the  location,  shape,  depth,  etc.,  of  the  wound  should  be 
carefull}'  noted  to  see  if  an  accidental  fall  would  be  likely  to 
account  for  it.  For  these  features  of  the  wound  may  be  such 
that  no  fall  could  cause  it. 

We  see,  therefore,  that  in  incised  and  punctured  wounds  the 
use  of  a  weapon  may  not  be  hard  to  make  out,  but  that  in  gen- 
eral the  question  M^hether  a  particular  instrument  caused  the 
wound  is  often  difficult  or  impossible  to  answer.  Often  the 
best  we  can  do  is  to  say  that  the  wound  could  have  been  pro- 
duced by  the  weapon. 

IV.     Was  a  Wound  Self-Inflicted  or  was  it  Inflicted 
BY  Another  ? 

In  other  words,  was  it  suicidal  or  homicidal  f  Speaking 
of  suicide  in  general,  its  most  common  cause  is  alcoholism. 
It  is  not  infrequent  in  youth.  Lutaud '  states  that  in  fifteen 
years,  presumably  in  France,  there  were  1,065  cases  of  suicide 
between  the  ages  of  ten  and  fifteen  years.  This  seems  to 
be  only  explicable  on  the  ground  of  heredity  or  of  cerebral 
affections.  Among  27,737  cases  of  suicide,  observed  in 
France,  the  same  author  gives  the  following  commonest  causes 
in  the  order  of  greatest  frequence :  Drowning,  strangulation, 
pistol-wounds,  incised  and  punctured  wounds,  poison.  The 
age,  sex,  and  social  conditions  influence  the  choice  of  means. 
Thus  among  males  drowning  is  preferred  by  the  young,  pistol- 
wounds  by  the  adult,  and  hanging  by  the  aged,  while  among 
females  asphyxia  is  the  favorite  method,  as  there  is  no  pain 
and  no  disfigurement. 

While  many  pathologists  consider  suicide  an  act  of  mental 
alienation,  and  though  such  may  be  the  case  in  a  large  number 
or  even  in  a  majority  of  cases,  yet  in  a  considerable  number  it  is 
'Lutaud:  "Mau.  d.  Med.  Leg. , "  5th  Ed. ,  1892. 


52G  WOUNDS — WOOLSEY. 

a  voluntary  and  rationally  planned  act.  The  question,  Is  it  sui- 
cide or  homicide?  may  bo  put  in  all  cases  of  death  by  cutting 
instruments,  and  in  many  from  other  kinds  of  wounds.  It  is 
often,  if  not  generall}^,  impossible  to  answer  it  with  absolute 
certaint}'.  It  is  hardly  suitable  for  the  medical  witness  to  try 
to  reconstruct  the  scene  of  the  crime  from  the  medical  facts, 
for  he  should  abstain  from  everything  not  medical  and  should 
distinguish  that  which  is  positively  proven  from  that  which  is 
merely  probable. 

Suicides  often  leave  a  letter  or  some  such  indication  to  show 
that  the  wound  was  self-inflicted.  If  such  is  not  the  case,  the 
question  as  to  the  cause  of  the  wound  may  or  may  not  be  med- 
ical. If  the  question  is  a  medical  one,  there  are  certain 
points  to  notice  as  to  the  wound,  such  as  its  nature,  situation, 
direction,  and  the  number  and  extent  of  the  wounds,  from 
which  we  are  to  form  an  opinion.  There  are  also  other  cir- 
cumstances which  furnish  evidence  and  thus  assist  us  in  an- 
swering the  question.  This  evidence  is  furnished  by  the 
weapon,  the  signs  of  struggle,  the  examination  of  the  clothes 
and  body  of  the  deceased  and  the  accused,  the  position  and 
attitude  of  the  body,  and  any  organic  lesions,  etc. ,  predisposing 
to  suicide. 

The  nature  of  the  wound  bears  upon  the  question  of  the 
homicidal  or  suicidal  origin  in  the  following  way:  Most  sui- 
cidal wounds  are  incised  or  punctured  wounds.  Incised  woiinds 
of  the  throat  are  generally  presumptive  of  suicide,  but  a  homi- 
cidal wound  may  be  inflicted  here  to  conceal  the  source  of  in- 
fliction of  the  wound.  Such  a  wound  if  homicidal  would  imply 
malice,  on  account  of  the  attempt  at  deception  and  concealment, 
and  would  convict  the  assailant  of  murder.  Unless  the  de- 
ceased was  asleep  or  drunk  or  was  otherwise  incapable  of  resist- 
ance, such  a  homicidal  wound  can  often  be  distinguished  from 
a  similar  suicidal  wound  by  the  form  and  direction  of  the 
wound,  by  its  irregularity,  and  by  other  wounds  on  the  hands  or 
person  of  the  deceased.  Taylor '  mentions  a  case  in  which  the 
peculiar  form  of  the  wound,  like  that  made  by  butchers  in  kill- 
ing sheep,  led  to  the  suspicion  that  homicide  had  been  com- 
mitted by  a  butcher,  who  was  subsequently  arrested,  tried,  and 
convicted  of  murder.  The  regularity  of  the  wound  has  been 
'"Med.  Jurisprudence,"  11th  Amer.  Ed.,  1892. 


THE   NATURE   AND    POSITION   OF   THE    WOUND.  527 

taken  to  indicate  suicide  rather  than  homicide.  That  it  does 
so  is  not  questioned,  but  it  is  more  or  less  fallacious  if  resistance 
is  impossible,  in  which  case  a  murderer  may  easily  make  a 
regular,  clean,  incised  wound  here.  Contused  ivounds  are  sel- 
dom suicidal,  for  they  are  not  sufficiently  speedily  or  certainly 
fatal.  They  are  also  more  painful  and  disfiguring.  Contused 
wounds  usually  indicate  murder  or  accident,  though  there  are 
not  wanting  cases  of  suicide  by  such  weapons  as  a  hatchet  or  a 
hammer.  There  is  more  difficulty  in  the  case  of  a  contused 
wound  from  a  fall  instead  of  from  a  weapon ;  for  here  we  have 
to  decide  whether  the  fall  was  accidental,  suicidal,  or  homi- 
cidal. The  nature  of  the  wound  is  of  little  assistance  in  the 
case  of  insane  or  delirious  patients,  who  may  commit  suicide 
in  the  most  unusual  and  curious  manner. 

Taylor'  relates  the  case  of  a  delirious  patient  in  Guy's 
Hospital,  in  1850,  who  tore  away  the  whole  of  the  abdominal 
muscles  from  the  lower  part  of  the  anterior  abdominal  wall. 
If  the  case  had  not  occurred  in  the  hospital  or  where  there  Avere 
witnesses  of  the  deed,  the  nature  of  the  wound  would  have  in- 
dicated homicide  except  for  the  delirium.  The  following  case, 
quoted  by  the  same  author,  illustrates  a  wound  of  very  unusual 
nature  and  situation,  which  might  have  been  taken  for  a  homi- 
cidal wound  with  intent  to  conceal  as  far  as  the  situation  of  the 
wound  was  concerned.  The  wound  was  accidental  and  occurred 
in  the  following  way.  A  girl  fifteen  years  old  jumped  on 
to  her  uncle's  knee  while  he  was  holding  a  stick  between  his 
legs  which  she  did  not  notice.  The  stick  passed  up  her  anus, 
but  she  withdrew  it  and  went  on  playing,  though  she  com- 
23lained  of  pain.  On  the  following  night  acute  S3'mptoms  of 
peritonitis  set  in,  and  she  died  of  it  in  fortj^-eight  hours.  On 
post-mortem  examination  a  rent  was  found  in  the  anterior  part 
of  the  rectum  penetrating  the  peritoneal  cavity. 

The  Situation  or  Position  of  the  Wound. — A  suicidal 
wound  must  be  in  such  a  position  that  the  deceased  could  have 
inflicted  it  himself.  Such  wounds  are,  therefore,  generally  an- 
teriorly or  laterally  situated.  The  "  site  of  election"  for  suicidal 
wounds  is  the  neck  for  incised  wounds  and  the  chest,  espe- 
cially in  the  region  of  the  heart,  for  punctured  wounds. 
The  situation  of  suicidal  wounds,  of  lunatics,  etc.,  shows  all 
»"Med.  Jurisprudence,"  11th  Amer.  Ed.,  1892. 


528  WOUNDS — WOOLSEY. 

kinds  of  fantasies.  The  mere  situation  does  not  suffice  to  dis- 
tinguish suicidal  wounds,  as  a  murderer  may  simulate  a  suicidal 
wound  for  purposes  of  concealment.  Some  regard  a  wound  in 
the  back  as  proof  against  suicidal  origin,  but  it  is  not  so  much 
the  situation  of  a  wound  as  the  situation  taken  in  connection 
with  the  direction  which  furnishes  the  proof  against  suicide  in 
such  wounds. 

As  a  rule,  a  suicidal  wound,  besides  being  in  an  accessible 
part  of  the  body,  is  also  in  a  part  commonly  known  to  be  rapidly 
mortal,  as  the  neck  and  heart.  But  suicidal  wounds  are  not 
always  in  the  situation  which  is  anatomically  best  for  being 
rapidly  fatal.  Concealed  wounds  or  wounds  in  inaccessible 
parts  presumptive  of  murder  may  be  suicidal  and  so  placed 
to  impute  them  to  another  and  give  rise  to  the  suspicion  of 
murder.  The  blood-vessels  of  the  arms  and  legs  may  be  selected 
as  the  site  of  a  suicidal  wound.  This  situation  is  often  re- 
garded as  uncommon,  though  the  writer  has  met  with  it  in  one 
or  more  cases  of  attempted  suicide.  It  is  illustrated  in  the 
famous  case  of  Abdul  Aziz,  the  Sultan  of  Turkey.  He  was 
found  dead  under  suspicious  circumstances  with  two  oblique, 
ragged  wounds  at  the  bend  of  each  elbow,  directed  from  above 
downward  and  from  within  outward.  The  joint  on  the  left 
side  was  penetrated,  while  only  the  skin  and  veins  were  in- 
volved on  the  right  side.  Death  was  due  to  bleeding  from 
the  ulnar  artery  and  the  veins.  The  clothing  was  soaked 
with  blood  and  scissors  stained  with  blood  were  found  on 
the  sofa.  These  wounds  were  consistent  with  suicide,  though 
not  what  would  be  expected.  Nineteen  physicians  who  ex- 
amined the  body  agreed  in  reporting  it  as  suicidal,  though, 
one  reason  given  for  this  opinion,  namely,  "  that  the  direction 
and  nature  of  the  wounds,  as  well  as  the  instrument  which 
might  have  effected  them,  lead  to  the  conclusion  of  suicide," 
was  hardly  a  valid  one,  for  the  wounds  were  not  typical  of  sui- 
cide in  nature,  direction,  or  position.  Such  wounds  are  rarely 
homicidal,  though  at  least  one  such  case  is  mentioned. 

Suicidal  incised  wounds,  as  has  been  said,  are  usually  in  the 
neck,  where  they  may  sometimes  be  arrested  by  the  larynx, 
especially  if  it  be  ossified,  though  the  incision  often  divides  the 
larynx.  The  situation  of  the  wounds  is  often  between  the 
larynx  and  the  hyoid  bone,  and  then  meeting  no  bony  resist- 


DIRECTION   OF   THE   WOUND.  529 

ance,  they  may  divide  the  great  vessels  and  even  nick  the  ver- 
tebrae. But  it  is  rare  to  be  so  deep,  at  least  on  both  sides  at 
once.  As  a  rule,  it  is  deepest  on  the  side  on  which  it  is  begun 
and  ends  more  superficially.  As  far  as  the  situation  of  a 
wound  is  concerned,  there  is  no  wound  which  a  suicide  can 
inflict  but  what  may  also  be  inflicted  by  a  murderer.  The  re- 
verse, however,  is  not  true.  We  cannot  always  certainly  dis- 
tinguish between  suicidal  and  homicidal  wounds  from  their 
situation. 

The  direction  of  the  ■wound  is  one  of  the  most  impor- 
tant points  to  notice.  It  is  considered  by  some  to  furnish  pre- 
sumptive evidence  for  the  medical  jurist,  and  taken  in  connec- 
tion with  the  nature  and  situation  of  the  wound  may  often 
lead  us  to  a  positive  opinion  as  to  the  question  of  the  suicidal 
or  homicidal  nature  of  a  wound.  The  evidence  from  the  direc- 
tion of  wounds  is  only  furnished  by  incised  and  punctured 
wounds,  rarely  by  contused  wounds.  Suicidal  incised  wounds 
of  the  throat  are  almost  always  directed  from  above  downward 
and  from  left  to  right  if  the  suicide  be  right-handed,  and  in  the 
same  direction  from  right  to  left  if  the  person  be  left-handed. 
Transverse  wounds  in  this  situation  without  obliquity  are  also 
compatible  with  suicide,  though  perhaps  more  common  in  homi- 
cide, while  obliquely  transverse  wounds  from  above  down- 
ward and  from  right  to  left  in  a  right-handed  individual  are 
indicative  of  their  infliction  by  another.  Homicidal  incised 
wounds  of  the  neck  inflicted  from  behind  or  the  right  side,  if 
the  victim  and  assailant  are  right-handed,  or  from  the  left  side 
if  they  are  left-handed,  may  have  the  same  direction  as  similar 
suicidal  wounds.  Such  a  wound  may  be  inflicted  by  a  mur- 
derer to  deceive  as  to  the  cause  of  the  wound  by  raising  the 
suspicion  of  suicide.  If  an  incised  wound  of  the  throat  be  in- 
flicted' b}^  another  from  in  front,  then  its  direction  is  usually  the 
reverse  of  a  similar  self-inflicted  wound. 

Homicidal  incisions,  especially  in  the  throat,  may  extend  at 
one  or  the  other  end  beyond  the  skin  wound.  In  similar  sui- 
cidal wounds  at  both  angles  of  the  wound  the  skin  is  the  first 
and  the  last  part  injured,  and  in  such  wounds  the  spine  is  sel- 
dom reached.  It  should  be  borne  in  mind  in  this  connection 
that  a  given  suicide  may  be  ambidextrous  and  this  fact  may 
be  unknown  to  the  friends  of  the  deceased.  This  is  especially 
84 


530  WOUNDS — WOOLSEY. 

the  case  in  the  use  of  the  razor  from  practice  in  shaving,  and 
the  razor  is  the  usual  weapon  used  in  such  incised  wounds  of 
the  throat.  Neglect  of  this  point  may  lead  to  an  unwarranted 
suspicion  of  murder.  The  two  following  cases  cited  by  Taylor ' 
well  illustrate  this  fact : 

In  the  case  of  Sellis,"  the  man  was  generally  supposed  to  be 
right-handed,  though  he  was  found  dead  in  bed  with  his  throat 
cut  and  the  razor  on  the  left  side  of  the  bed.  In  point  of  fact, 
he  was  ambidextrous  in  the  use  of  the  razor.  The  second  case, 
which  occurred  in  London  in  1865,  was  still  more  remarkable. 

A  publican  was  found  dead  in  bed  with  his  throat  cut  in  a 
left-handed  manner.  He  was  supposed  to  be  right-handed  and 
there  was  bloody  water  in  a  basin  in  the  room.  His  wife,  who 
gave  the  alarm,  had  marks  of  bruises  on  her,  and  though  she 
said  she  had  found  her  husband  dead  in  bed  after  having  left 
it  for  a  short  time,  suspicion  fell  upon  her,  especially  as  they 
were  in  the  habit  of  quarrelling.  The  suspicions  were  removed, 
however,  by  the  explanation  that  he  had  been  brought  up  as  a 
wood-carver,  which  required  him  to  use  both  hands  equallj-,  and 
that  he  had  frequentl}^  threatened  to  kill  himself,  and  further 
that  the  bloody  water  in  the  basin  was  due  to  a  daughter  wash- 
ing her  hands  after  having  touched  her  father.  It  is  even  con- 
ceivable that  an  ambidextrous  person,  to  avoid  suspicion  of  sui- 
cide or  to  impute  murder  to  another,  might  inflict  a  suicidal 
wound  from  right  to  left.  Notwithstanding  all  this,  the  above 
cases  are  very  rare  exceptions,  and  the  rules  stated  above  as  to 
incised  wounds  in  the  throat  hold  in  almost  every  case. 

In  the  case  of  stab-wounds  of  the  chest,  especially  in  the 
cardiac  region,  the  same  rule  as  to  the  direction  holds  good, 
and  in  these  wounds  we  can  often  define  the  direction  more 
accurately  than  in  the  case  of  incised  wounds.  If  the  suicide 
is  right-handed  the  wound  is  regularly  on  the  front  or  side  of 
the  body  and  directed  obliquely  from  above  downward  and  from 
right  to  left,  while  it  is  from  left  to  right  in  case  of  a  left- 
handed  suicide.  A  murderer  from  behind,  or  from  that  side 
the  hand  of  which  the  victim  would  use,  may  inflict  a  w^ound  in 
the  same  situation  and  direction  as  a  suicidal  one.  Here  again 
this  ma}^  be  done  with  the  motive  of  concealment  of  the  nature 

'Taylor:    "Med.   Jiu-ism-udence, "  '■* Willis:     "Circumstantial    Evi- 

11th  Amer.  Ed.,  1892.      "  dence,"  p.  97. 


THE   NUMBER   AND    EXTENT   OF    WOUNDS.  5:31 

of  the  crime.  Homicidal  stab- wounds  inflicted  from  in  front,  as 
they  generally  are,  are  usually  directed  from  left  to  right,  and 
they  may  be  directed  from  above  downward  or  in  the  oi^posite 
direction.  Oblique  wounds  from  above  downward  may  be  either 
suicidal  or  homicidal;  those  directed  from  below  upward  are 
almost  always  homicidal. 

When  a  wound  is  caused  by  an  instrument  both  cutting  and 
puncturing,  suicide  cannot  be  admitted  unless  the  direction  of 
the  wound  is  compatible  with  that  which  the  weapon  which 
inflicted  the  wound,  held  in  the  hand  of  the  deceased,  might 
cause.  Ta^'lor  recommends  to  place  the  weapon  in  the  hand 
of  the  deceased  to  see  if  the  direction  of  the  wound  could  possi- 
blj^  correspond  with  that  which  could  be  taken  by  the  weapon 
in  the  liand  of  the  deceased  with  any  position  possible  for  the 
arm  and  hand.  Therefore  certain  wounds  by  position  and  di- 
rection exclude  suicide,  but  if  a  wound  is  possibly  suicidal  it 
is  also  possibly  homicidal. 

Though  suicidal  wounds  vaiy,  the  above  points  are  some- 
times of  real  assistance  in  distinguishing  between  suicide  and 
homicide,  especially  if  the  bod}'  has  not  been  moved. 

Evidence  Furnished  by  the  Number  and  Extent  of 
"Wounds. — Multiplicity  of  wounds,  as  a  rule,  indicates  homi- 
cide, and  indeed  the  reverse  is  true  in  a  majoritj'of  cases  that  a 
single  wound  points  to  suicide.  There  are  many  exceptions, 
however,  to  both  statements.  Multiple  wounds  are  possible  in 
suicide,  and  that,  too,  with  dijfferent  weapons;  even  drowning  or 
hanging  may  be  resorted  to  after  self-inflicted  wounds  have 
failed.  If  several  wounds  are  found,  each  one  of  which  or  more 
than  one  of  which  may  be  considered  grave,  it  is  usual  to  con- 
clude that  the  wounds  were  not  self-inflicted,  but  the  medical 
expert  should  not  judge  too  hastily  from  this  fact  alone,  for 
most  wounds  do  not  kill  instantly.  With  the  presence  of  sev- 
eral wounds  in  a  case  of  suicide  only  one  of  these,  as  a  rule,  is 
"mortal"  in  character.  This  being  so,  some  have  asserted  that 
if  two  mortal  wounds  are  present,  especially  if  one  of  them  is 
stupefying,  such  as  a  wound  about  the  head,  such  wounds  are 
incompatible  with  suicide.  A  definite  statement  of  this  kind 
cannot  go  unchallenged  unless  the  two  wounds  are  in  different 
parts  of  the  body,  and  both  of  such  a  ^)ature  as  to  be  imme- 
diately or  very  rapidly  fatal.     For  all  cases  of  suicide  or  liomi- 


532 


WOUNDS — WOOLSEY. 


'■rn  ^ 


cide  do  not  die  immediately  from  wounds  commonly  called 
mortal ;  in  fact,  this  may  be  said  to  be  the  exception  rather  than 
the  rule.  We  may  safely  say,  however,  that  if  there  are  sev- 
eral distinct  wounds  on  the  throat,  each  involving  the  large 
vessels,  the  inference  is  plainly  murder. 

Several  wounds  by  the  same  or  different  weapons  cannot, 
therefore,  be  proof  of  homicide.  The  case  of  a  lunatic  suicide 
is  reported  who  inflicted  thirty  wounds  upon  his  head.  In  a 
case  of  homicide  with  multiple  wounds  the  situation  or  direc- 
tion of  some  one  or  more  of  them  may  give  evidence  as  to  the 
origin  of  the  wounds.    Ogston,  Sr.,'  states  that  especially  in  the 

case  of  incised  wounds 
of  the  throat  a  suicide 
may  make  a  number 
of  small  or  superficial 
tentative  cuts  besides 
the  principal  one,  but 
these  incisions  are  all 
usually  parallel  (see 
Fig.  10).  In  the  case 
of  multiple  homicidal 
incised  wounds  of  the 
throat,  on  the  other 
hand,  the  wounds  are 
not  parallel,  o  w  i  n  g 
probably  to  the  resist- 
ance of  the  victim  in 
this  case  and  his  remaining  passive  in  the  former.  The 
extent  of  the  wound  refers  to  the  number  and  importance  of 
the  parts  injured.  In  regard  to  incised  wounds  of  the  neck, 
this  point  has  been  thought  by  some  to  furnish  presumptive 
evidence  of  suicide  or  homicide — of  homicide  if  the  wounds 
are  deep,  of  suicide  if  they  are  not.  While  it  is  true  that 
suicidal  wounds  of  the  neck  are,  as  a  rule,  not  very  deep,  and 
that  they  seldom  reach  the  vertebrae  and  generally  do  not  di- 
vide the  vessels  on  more  than  one  side,  yet  sometimes  such 
wounds  are  as  deep  and  extensive  as  homicidal  ones..  This 
may  imply  a  determined  purpose  not  to  be  foiled  in  the  attempt 
at  suicide.  Thus  Marc  reports  a  case  of  suicide  by  an  incised 
'  "Lectures  on  Med.  Jurisprudence,"  p.  424. 


N. 


Fig.  10.— Suicidal  Cut  Throat  from  Left  to  Right, 
showing  the  Tentative  Cuts  at  the  Commencement  and 
the  Serrations  at  the  Termination  of  the  Wound. 


EVIDENCE   FURNISHED    BY   THE    WEAPON. 


533 


wound  of  the  neck,  where  the  wound  was  so  deep  as  to  reach 
the  vertebrae  or  their  anterior  ligaments  and  to  divide  the 
trachea  and  oesophagus,  both  carotids  and  jugular  veins.  The 
extent  of  this  wound  was  greater  than  in  most  suicides,  but 
still  we  can  hardly  lay  down  a  hard-and-fast  rule  of  much 
practical  value  according  to  M^hich  extensive  wounds  are  evi- 
dence of  murder.  Such  wounds  are,  however,  presumptive  of 
murder  taken  in  connection  with  other  signs  pointing  that  way. 

The  question  may  arise  in  regard  to  a  wound,  whether  the 
victim  tvounded  himself  by  precipitating  himself  on  the 
weapon.  This  may  bo  alleged  by  the  defence,  but  it  is  diffi- 
cult to  believe  if  the  wound  is  deep,  for  the  body  would  natu- 
rally repulse  the  weapon. 
If  the  wound  is  deep  the 
weapon  must  at  least  have 
been  strongly  held,  which 
may  or  may  not  be  consist- 
ent with  the  theory  of  self- 
defence.  If  the  direction 
of"  the  wound  is  oblique 
from  above  downward,  or  if 
there  is  one  external  wound 
and  two  separate  tracts 
internally,  from  a  second 
use  of  the  weapon  on  the 
part  of  the  person  hold- 
ing it,  then  the  above  allegation  is  doubtful,  if  not  impossible. 

By  comparing  the  relative  positions  of  the  deceased  and 
accused,  as  indicated  by  the  witnesses  and  accused,  with  the 
position  and  direction  of  the  wound,  we  may  often  judge 
whether  the  allegation  is  possible  or  probable. 

Besides  the  above  points  derived  from  the  w^ound  itself, 
there  are  several  other  factors  which  belong  to  the  categor}-  of 
circumstantial  evidence,  but  which  come  within  the  province 
of  the  medical  expert.  These  latter  points  of  evidence  are 
sometimes  almost  as  important  as  the  former,  while  taken  in 
connection  with  them  they  help  to  make  the  evidence  far  more 
conclusive. 

Evidence  furnished  by  the  weapon  as  to  the  origin 
of  wounds. 


Fig.  11.— Homicidal  Cut  Throat  from  Right 
to  Left,  showing  a  Tentative  Cut  at  the  Coin- 
iiiencement  and  the  Serrations  at  the  Termina- 
tiiin  of  the  Wound. 


534  WOUNDS — WOOLSEY. 

We  have  already  seen  in  a  former  section  that  we  can  often 
tell,  by  various  signs  of  the  wound,  with  what  kind  of  a  weapon 
it  was  made.  We  may  thus  be  able  to  say  that  a  wound  was 
made  by  a  weapon  similar  to  one  exhibited.  Also  by  examina- 
tion of  the  weapon  itself  and  from  the  circumstantial  evidence 
of  where  and  how  it  was  found,  we  may  sometimes  say  that 
the  wound  was  inflicted  almost  certainly  with  a  particular 
weapon.  All  this  evidence  ma}'  sometimes  be  made  use  of  in 
judging  between  the  suicidal  and  homicidal  origin  of  a  wound. 

The  POSITION  of  the  iveapon  or  the  place  where  it  is  found  is 
a  matter  of  considerable  importance.  If  it  has  not  been  touched, 
its  position  should  be  carefully  examined,  or  inquired  about  if  it 
has  been  moved.  The  presence  of  a  weapon  which  might  have 
caused  the  wounds  in  the  hand  of  the  victim  is  in  general  proof 
of  suicide.  The  weapon  must  not  merel}'  lie  in  the  hand,  it 
mast  be  gripped  by  the  hand.  One  might  suppose  that  the 
weapon  placed  and  held  in  the  hand  until  rigor  mortis  sets  in 
would  still  be  firmly  held.  Casper  says  that  this  is  not  so, 
but  that  the  weapon  falls  from  the  grasp  as  soon  as  the  hand 
is  unbound.  Also  Hofmann's '  experiments  proved  the  satne 
point.  By  the  use  of  ligatures  and  several  artificial  means  he 
tried  to  confine  a  weapon  in  the  hand  of  a  recenth'  dead  body 
so  that  it  would  be  as  firmlj'  held  as  hj  a  contraction  of  the  mus- 
cles during  life.  These  experiments  were  entirely  unsuccessful, 
for  though  the  fingers  remained  closed,  the  object  was  simply 
held  and  not  grasped,  and  fell  from  the  hand  on  the  release  of 
pressure. 

In  suicide  the  weapon  is  sometimes  held  so  firmly  that  force 
is  required  to  dislodge  it.  It  seems  as  if  the  muscular  spasm 
or  grip  persists  after  death,  as  cadaveric  spasm,  until  rigor 
mortis  occurs  and  sets  it,  as  it  were.  The  murderer,  therefore, 
cannot  imitate  this  grip,  and  an  unsuccessful  attempt  to  do  so 
would  indicate  murder.  It  should  be  borne  in  mind  that  the 
weapon  in  the  hand  of  the  deceased  maj  have  been  for  the  pur- 
poses of  defence ;  therefore  it  is  necessary  to  note  whether  the 
wounds  on  the  body  correspond  to  those  which  could  be  made 
by  the  weapon.  Indeed,  this  fact  is  most  important  to  note  in 
all  cases  of  suspected  suicide  where  the  weapon  is  found.  If 
the  weapon  is  not  in  the  hand  of  the  deceased,  note  carefuUy 
'See  "Med.  Leg. ,"ti-ad.  par  Brouardel,  p.  601. 


EVIDENCE    FURNISHED    BY    THE    WEAPON.  535 

where  it  lies.  If  death  is  due  to  a  suicidal  or  accidental  wound 
which  is  immediately  or  very  rapidly  fatal,  the  weapon  is  gen- 
erally found  near  the  body.  If  so,  it  is  well  to  note  on  which  * 
side  it  lies,  and  if  it  lies  near,  whether  it  has  apparently  fallen 
or  been  thrown  or  placed  there.  If  the  relation  of  the  body  and 
the  weapon  has  been  disturbed  by  moving  either,  the  position 
of  the  weapon  as  found  by  the  medical  witness  is  of  little  value. 
In  cases  of  suicide  the  weapon  may  possibl}^  be  found  at  some 
distance  or  even  concealed,  though  this  is  exceptional.  Thus 
Taylor '  states  that  the  razor  in  one  instance  was  found  shut  at 
the  side  of  the  deceased,  who  had  committed  suicide  by  cutting 
his  throat.  In  another  instance  the  razor  was  found  in  the 
pocket  of  the  deceased,  bloody  and  closed.  As  a  rule,  the 
weapon  is  found  Ijnng  at  the  side  of  a  suicide  if  it  is  not  grasped 
in  the  hand.  If  the  weapon  is  far  from  the  bod}'  and  the  wound 
was  quickly  fatal,  especially  if  the  weapon  is  hid  or  cannot  be 
found,  it  is  strongly  presumptive  of  murder.  If  the  weapon  is 
found  near  the  body  it  is  well  to  note  whether  the  edge  is  sharp 
or  blunt,  straight  or  bent,  or  notched,  as  these  points  maj^  assist, 
us  in  forming  a  judgment  as  to  suicide  or  murder. 

A  weapon  belonging  to  the  victim  ma}'  be  substituted  by 
the  murderer  for  the  one  really  used,  and  the  former  may  be 
placed  by  the  side  of  the  bodj-.  Therefore  the  weapon  found 
should  correspond  to  the  wounds  as  to  length,  depth,  sharpness, 
etc.,  to  be  compatible  with  suicide. 

Generally  a  suicide  foiled  in  the  attempt  to  take  his  life 
uses  the  same  weapon  over  again  if  he  persists  in  the  attempt. 
But  he  may  not  do  so ;  on  the  contrary,  if  the  first  attempt  was 
made  with  a  knife,  the  second  ma}'  be  made  with  a  pistol,  etc. 
Several  wounds  by  the.  same  or  different  weajwns  cannot 
therefore  be  an  absolute  proof  of  homicide. 

The  presence  of  blood,  hair,  and  other  substances 
on  the  weapon  used,  or  probably  used,  is  a  matter  of  some 
importance.  Blood  is  not  necessarily  found  on  the  weapon  used 
to  inflict  a  mortal  wound,  especially  in  the  case  of  blunt  instru- 
ments. In  stab-wounds,  too,  the  vessels  may  be  compressed  by 
the  blow  or  the  weapon  may  be  wiped  as  it  were  on  withdrawal 
by  the  elasticity  of  the  skin  and  by  the  clothing,  except  for  a 
thin  yellowish  film.  Thus  it  is  that  the  first  stalvwound  shows 
'"Med.  Jurisprudence,"  11th  Amer.  Ed.,  1892. 


636  WOUNDS — WOOLSEY. 

110  blood  on  the  outside  of  the  clothes  but  only  on  the  inside, 
but  the  outside  of  the  second  is  usually  bloody  but  may  be  but 
'little  so.  To  make  sure  whether  or  not  there  is  blood  on  a  knife 
or  other  weapon  it  is  necessary  to  examine  all  the  depressions 
on  the  instrument,  as  the  blade  itself  may  have  been  washed, 
and  only  those  traces  of  blood  remain  which  are  less  accessible 
to  cleaning  by  washing.  Blood  coagulated  on  a  blade  indicates, 
as  a  rule,  blood  from  a  living  animal,  but  it  may  not  do  so. 
Furthermore,  it  may  be  hard  to  distinguish  between  a  thin 
layer  or  spots  of  dried  blood  not  coagulated  or  coagulated  and 
dried  blood  in  a  similar  form. 

If  blood  is  not  found  on  a  weapon,  hair  and  other  substances 
which  can  be  identified  may  be.  This  is  especially  the  case 
with  blunt  weapons,  on  which,  as  we  have  seen,  blood  usually 
fails.  A  fragment  of  the  weapon  may  break  off  in  the  wound, 
as  in  stab-wounds,  and  may  be  identified  as  belonging  to  one  in 
the  murderer's  possession. 

The  signs  of  a  struggle  furnish  important  evidence,  as 
they  are  not  likely  to  be  found  in  the  case  of  suicide.  If  the 
wounds  were  inflicted  by  a  cutting  instrument,  the  existence 
of  a  struggle  may  be  indicated  by  incisions  on  the  palm  of  the 
hand  or  fingers  or  on  the  dorsum  (see  Fig  12).  Such  wounds 
would  not  be  self-inflicted  and  would  indicate  a  struggle  with  the 
murderer.  Or  if  contusions  or  ecchymoses  indicating  the  form 
of  the  foot,  fist,  fingers,  or  finger-nails  are  found  on  the  face,  neck, 
chest,  forearm,  or  hand  of  the  deceased,  this  again  indicates  a 
struggle  with  the  assailant,  and  goes  far  to  prove  murder.  The 
same  is  true  of  the  imprint  of  a  bloody  or  dirty  hand  on  the  clothes 
of  the  victim  when  the  victim's  hands  were  not  bloody.  Also 
such  an  imprint  in  a  position  where  the  deceased  could  not  have 
reached  with  the  particular  hand  indicated,  as  is  the  case  if  the 
impression  of  a  right  hand  be  found  on  the  victim's  right  arm; 
this  indicates  a  struggle  with  a  murderer,  etc.  In  one  case  of 
murder,  on  the  back  of  the  left  hand  of  the  deceased  there  was 
found  the  bloody  mark  of  a  left  hand  evidently  not  tjiat  of  the 
victim  himself.  The  presence  of  marks  of  violence  about  the 
mouth  of  the  deceased,  done  to  close  it  to  prevent  the  victim 
from  giving  an  alarm,  especially  if  surprised  during  sleep,  is 
presumptive  of  murder.  Sometimes  hair  or  fragments  of  cloth- 
ing belonging  to  the  accused  are  found  in  the  grasp  of  the  de- 


THE   SIGNS   OF   A    STRUGGLE.  537 

ceased,  indicating  a  desperate  struggle,  and  they  are  very  sus- 
picious of  murder.  Thus  Taylor '  cites  the  case  of  a  murder 
trial  in  Ireland,  in  1877,  where  hairs  found  firmly  grasped  in 
the  hands  of  the  deceased  were  found  to  correspond  to  the  hair 
of  the  accused.  The  clothes  of  the  deceased,  as  well  as  those 
of  the  accused,  often  indicate  a  struggle  unless  the  accused  can 


Fig.  12.— Incised  Wounds  of  Right  Hand  in  the  Struggle  of  Defence.    Homicide. 

satisfactorily  account  for  the  condition  of  his  own  clothes  in 
some  other  way. 

The  examination  of  the  clothes  and  body  of  the  de- 
ceased and  the  accused  may  furnish  important  evidence. 

If  suicide  is  accomplished  by  a  weapon  like  a  knife,  it  is 

rare  for  the  hand  not  to  be  bloody.     If  it  is  not  bloody  we  may 

well  suspect  a  case  of  supposed  suicide.     The  presence  of  blood 

on  the  hand  does  not  prove  suicide,  though  its  absence  may 

'"Med.  Jurisprudence,"  11th  Auier.  Ed.,  1892. 


538  WOUNDS — WOOLSEY. 

disprove  it,  as  the  hand  is  generally  bloody  in  case  of  murder 
by  being  carried  to  the  wound. 

The  examination  of  the  clothing  of  the  deceased  is  of  great 
importance.  As  we  have  noticed  before,  a  suicide  generally 
opens  them,  a  murderer  rarely.  A  suicide  is  often  partly  or 
even  wholly  undressed  when  he  inflicts  the  wound,  while  mur- 
der is  usually  committed  on  those  entirely  dressed.  The  wound 
of  the  clothes  should  correspond  to  that  of  the  body  in  case  of 
murder.  In  suicide  the  wounds  of  the  body  and  of  the  clothes 
may  not  correspond,  especially  if  there  exists  a  motive  to  falsely 
impute  the  crime.  The  clothes  of  the  deceased  as  well  as  those 
of  the  accused  may  indicate  a  struggle,  as  we  have  already 
noticed.  Of  course,  in  regard  to  the  clothes  examined,  it  is 
necessary  to  clearly  prove  that  they  were  worn  at  the  time  by 
the  deceased  or  accused,  otherwise  serious  mistakes  may  be  and 
sometimes  are  made.  In  examining  the  blood-spots  on  the 
clothing,  note  whether  the  blood  occurs  in  large  patches  or 
sprinkled  as  by  a  spurting  vessel  or  by  continued  violence. 

The  body  of  the  accused  may  present  scratches,  marks  of 
nails,  contusions,  bites,  or  other  wounds  indicative  of  a  struggle. 
It  would  be  well  to  ask  the  accused  how  he  received  the  wounds 
or  scars,  to  see  if  his  explanations  tally  with  the  injuries.  It 
is  hard  to  tell  when  wounds  which  have  cicatrized  were  in- 
flicted ;  we  can  only  distinguish  between  old  and  recent  ones, 
and  thus  control  the  statements  of  the  accused.  An  examina- 
tion of  the  finger-nails  of  the  prisoner  soon  after  the  crime  may 
reveal  blood  underneath  when  the  rest  of  the  hands  and  person 
are  free  from  it.  Note  also  the  site  and  shape  of  the  blood- 
spots,  if  they  exist,  and  whether  or  not  they  came  from  an 
arterial  jet.  These  spots  may  be  on  the  body  or  clothes  of  the 
accused.  The  account  of  the  accused  as  to  these  spots  may  or 
may  not  correspond  to  the  facts  as  indicated  by  them.  The 
above  leads  us  to  the  more  or  less  important  question : 

Could  the  Assailant  have  Escaped  without  Stains? 

It  is  possible  for  the  murderer  to  escape  without  being  spotted 
with  blood,  but  the  probability  of  this  occurrence  depends  on 
the  nature  of  the  wound  and  the  relative  positions  of  the  de- 
ceased and  the  assailant  at  the  time  the  wounds  were  inflicted. 
This  latter  fact  is  very  largely,  if  not  altogether,  a  matter  of 


BLOOD-STAINS   ON   THE   ASSASSIN.  530 

speculation  as  far  as  the  medical  evidence  goes.  It  is  a  popu- 
lar, though  false,  idea  that  a  murderer's  clothes  must  be  bloody, 
and  the  police  may  be  misled  in  expecting  to  find  them  so  in 
every  instance.  Taylor '  cites  several  cases  in  which  either  no 
blood  was  found  on  the  murderer's  clothes,  or  only  small  spots 
whollj^  out  of  proportion  to  the  amount  of  blood  which  must 
have  spurted  or  flowed  from  the  wound.  Absence  of  blood  on 
the  prisoner's  clothes  is  often  made  use  of  by  the  defence  to 
prove  the  prisoner's  innocence,  whereas,  besides  the  possibilities 
of  having  had  no  spots  in  the  first  place,  the  clothes  may  have 
been  changed  or  washed  before  the  examination  was  made. 
This  has  occurred  in  more  than  one  murder  trial.  Taylor' 
mentions  the  following  cases  in  illustration : 

It  was  alleged  that  the  absence  of  blood-stains  on  the  pris- 
oner's clothing  was  a  strong  proof  of  his  innocence  in  the  trial 
of  Sub-Inspector  Montgomery  for  the  murder  of  Mr.  Glasse 
(Omagh  Ass.,  July,  1873).  In  this  case  the  weapon  was  a 
bill-hook  which  had  produced  contused  wounds  on  the  head. 
There  was  blood  on  the  floor  about  the  body,  but  the  w^ounds 
were  not  likely  to  have  been  accompanied  by  much  spurting. 
Yet  it  was  assumed  that  the  assailant  in  this  case  must  have 
been  covered  with  blood.  Much  stress  was  laid  upon  the  ab- 
sence of  blood-stains.  On  the  first  two  trials  the  jury  could 
not  agree,  owing  chiefly  to  the  absence  of  blood- stains,  but  on 
the  third  trial  he  was  convicted  and  afterward  admitted  that  he 
had  removed  the  blood -stains  from  the  clothes  with  cold  water. 
Also  in  the  case  of  Reg.  v.  Courvoisier  (C.C.C,  1840)  the  ac- 
cused, who  was  tried  for  the  murder  of  Lord  William  Russel, 
had  no  blood-stains  on  his  clothes.  All  the  vessels  of  the  throat 
of  the  deceased  had  been  cut  to  the  vertebra3  while  he  was 
asleep.  It  was  contended  most  strongly  that  the  accused  could 
not  possibly  have  committed  the  crime,  as  he  had  no  blood- 
stains.- But  after  conviction  he  confessed  that  he  wore  no 
clothes  when  he  committed  the  murder,  and  he  only  had  to 
wash  his  hands  and  the  carving-knife  he  used.  Again,  in  the 
case  of  Reg.  r.  Thompson  (Durham  Wint.  Ass.,  180.'))  the  de- 
fence mainly  relied  on  the  absence  of  blood  on  the  prisoner's 
clothing.  The  wound  in  the  throat  of  the  wife  of  tlu^  accused 
was  five  inches  long,  directed  from  left  to  right,  dividing  all 
1  "  Med.  Jurisprudence, "  11th  Amer.  Ed. ,  1893. 


540  WOUNDS — WOOLSEY. 

the  vessels  and  nerves  of  the  neck.  The  medical  witness  stated 
justly  that  no  such  wound  could  be  self-inflicted.  It  was  rap- 
idly fatal.  No  weapon  was  found  near  the  body.  The  prisoner 
was  convicted. 

The  same  author  cites  the  case  of  a  prisoner  on  whose 
trousers  worn  soon  after  the  murder  no  blood-marks  were  found, 
but  the  trousers  actually  worn  by  him  were  found  with  blood 
upon  them.  Juries  have  even  acquitted  the  prisoner  apparently 
only  because  no  marks  of  blood  were  found,  though  the  other 
circumstances  were  explicable  only  on  the  theory'  of  murder. 

It  should  be  remembered  in  this  connection  that  blood-stains 
may  be  found  on  the  clothing  of  many,  especially  on  the  coarse 
clothing  of  working-people.  This  may  be  accounted  for  by  the 
occupation,  flea-bites,  accidental  circumstances,  or  it  may  occur 
without  definite  explanation.  Such  persons  may  be  accused  of 
murder  and  yet  the  blood-stains  be  consistent  with  innocence. 
Too  much  importance  should  not,  therefore,  be  attached  to 
them,  even  if  the  accused  cannot  satisfactorily  explain  them 
and  if  he  does  not  attempt  to  do  so  in  a  suspicious  way.  That 
blood  on  the  clothing  even  under  suspicious  circumstances  may 
be  consistent  with  innocence  is  illustrated  by  the  case  of  a  suicide 
by  cutting  the  throat,  in  1872,  cited  by  Taylor.'  In  this  case 
the  son  first  found  his  father  dead,  and  thought  that  he  had 
broken  a  blood-vessel.  He  raised  the  body,  staining  his  hands 
and  clothes,  then  went  for  help.  At  the  inquest  he  was  closely 
questioned  as  to  the  presence  of  the  blood-stains,  but  there  could 
be  no  doubt  that  the  case  was  one  of  suicide. 

In  general,  we  may  say  that  a  murderer  is  much  more  likely 
to  escape  without  blood-stains  in  contused  wounds,  and  more 
likely  in  the  case  of  punctured  wounds  than  in  incised  wounds, 
for  in  punctured  wounds  the  bleeding  is  much  less  free  and  is 
less  likel}^  to  spurt  from  the  wound.  In  the  case  of  incised 
wounds  ho  is  most  apt  to  escape  without  stains  if  he  is  behind 
or  to  the  side  of  the  victim  when  he  inflicts  the  wound — in  other 
words,  when  a  part  of  the  body  of  the  deceased  was  between  the 
assailant  and  the  wound  inflicted.  Furthermore,  the  assailant 
is  more  likely  to  escape  without  blood-stains  if  there  is  a  single 
wound  than  if  there  are  several,  and  each  additional  wound 
makes  it  more  likely  that  he  will  be  spotted  with  blood. 
'"Med.  Jurisprudence,"  11th Amer.  Ed.,  1892. 


EXAMINATION  OF  THE  GROUND,  FLOOR,  ETC.      5-il 

The  examination  of  the  ground  or  floor  and  the  furni- 
ture, etc.,  may  furnish  some  evidonce  as  to  the  nature  of  the 
crime,  and  also  help  the  witness  to  answer  the  questions  which 
may  sometimes  be  asked,  i.e.,  At  what  spot  was  the  victim 
"svouNDED?  and  Where  did  he  die?  This  question  is  some- 
times settled  by  examination  of  the  spot  where  the  deceased  la}'- 
and  the  furniture,  etc.,  about.  Sometimes  the  floor  or  ground 
and  the  furniture  or  surrounding  objects  at  a  distance  give  the 
requisite  evidence.  The  examination  of  the  cracks  and  corners 
of  the  floor  and  furniture  should  not  be  neglected,  and  Taylor 
instances  a  case  where  the  hair  of  a  dog  helped  to  clear  up  the 
case.  If  the  bod}^  has  not  been  disturbed  the  most  blood  is 
usually  found  where  the  deceased  died.  If  the  victim  succumbs 
at  the  spot  where  he  was  wounded,  blood  is  found  onh'  in  the 
immediate  neighborhood,  except  for  arterial  jets,  which  ma}'  be 
as  far  distant  as  two  metres.  The  separate  blood-spots  ©f  an 
arterial  jet  are  circular  if  the  jet  strikes-the  object  perpendicu- 
larly, oval  or  wedge-shaped  with  the  larger  end  away  from  the 
body  if  it  strikes  the  object  obliquely. 

If  the  blood-stains  are  more  diffused  and  are  found  in  other 
places,  careful  notice  should  be  taken  as  to  whether  the  differ- 
ent places  communicate  with  one  another  by  traces  of  blood. 
If  they  do  not  communicate,  it  goes  to  show  that  the  body  was 
moved  after  active  bleeding  had  ceased,  that  is,  after  death, 
but  this  indication  is  not  absolutely  positive.  If  traces  of  blood 
do  connect  the  larger  blood-spots,  it  is  of  interest  and  importance 
to  know  where  the  deceased  was  wounded  and  where  he  died, 
also  whether  he  moved  or  if  he  was  moved  before  or  after 
death.  This  question  is  not  ahvays  capable  of  solution.  Some 
injuries  exclude  the  possibility  of  active  motion.  Stupefying 
contused  injuries  of  the  head  or  an  incised  wound  opening  a 
great  artery  are  both  inflicted  where  there  is  the  greatest 
hemorrhage,  and  the  spot  where  the  deceased  was  wounded  and 
died  shovdd  be  identical.  In  such  cases  a  second  large  sj^ot  of 
blood,  connecting  or  not  with  the  first  wound,  indicates  that  the 
body  has  been  moved.  But  if  the  wound  does  not  bleed  much 
or  rapidly,  the  wounded  person  may  fall  at  a  distance  from  the 
spot  where  he  was  injured,  and  death  occurs,  as  a  rule,  where 
there  is  the  greatest  amount  of  blood ;  for  a  certain  amount  of 
bleeding  occurs  for  a  short  time  after  the  victim  falls  or  even 


542  WOUNDS — WOOI.se  Y. 

after  death.  One  can  find  in  many  i)laces  the  signs  of  arterial 
jets  marking  the  movement  pi  the  deceased  from  one  blood-spot 
to  another.  This  is  quite  different  from  the  tracks  caused  by 
dragging  a  bleeding  body.  All  this  it  is  important  to  notice, 
for  the  dragging  or  passive  moving  of  the  body  strongly  indi- 
cates murder.  Blood  at  a  distance  may  indicate  the  occurrence 
of  a  struggle,  or  that  the  body  was  moved,  or  it  may. show  the 
tracks  of  a  murderer.  As  to  the  latter  point,  tJie  imprints  of 
the  hands  and  feet,  whether  bloody  or  not,  may  indicate  murder 
and  establish  the  identity  of  the  murderer.  We  have  already 
seen  how  they  may  occur  on  the  deceased  and  indicate  a  strug- 
gle, and  thus  be  presumptive  of  murder.  When  the  marks  are 
made  by  the  naked  foot,  it  is  well  to  examine  it  by  lining  it  off 
in  squares,  and  so  to  compare  it  with  the  imprint  of  the  foot  of 
the  accused.  Simple  inspection  can  sometimes  give  the  required 
evidence.  We  may  even  get  an  impression  of  such  imprints  in 
the  snow.  Imprints  of  the  boots  or  shoes  worn  by  the  accused 
compared  with  those  imprints  found  at  and  near  the  scene  of 
the  crime  may  sometimes  help  to  clear  up  the  case,  but  this 
may  perhaps  be  considered  outside  of  the  sphere  of  the  med- 
ical witness.  Such  and  other  signs  of  a  struggle  about  one  of 
the  blood-spots  would  indicate  that  the  wound  Avas  received 
there,  though  death  may  have  occurred  at  another  spot.  In 
such  a  case  it  would  be  well  to  examine  to  see  if  there  was 
much  blood  where  the  body  was  found,  for  if  there  was  not  it 
would  indicate  that  the  body  had  been  moved  there  after  death, 
and  thus  be  strongly  presumptive  of  murder. 

As  furnishing  some  evidence  which  may  help  to  distinguish 
between  suicide  and  homicide  in  the  origin  of  wounds,  the 
question  may  be  asked,  What  was  the  position  of  the 
VICTIM   when   injured   OR  DYING?   and  also.  What  were 

the   relative   positions   of   the  VICTIM   AND    ASSAILANT? 

The  position  of  the  victim  at  the  moment  of  the  injury  is 
sometimes  indicated  by  the  position  of  the  wound,  the  direction 
of  its  tract,  and  the  direction  from  the  wound  of  the  blood  on 
the  body  and  clothes.  On  the  neck  or  extremities  the  course 
and  form  of  the  wound  may  indicate  the  position  of  these  parts 
when  the  wound  was  inflicted,  for  sometimes  in  flexions  of 
these  parts  the  skin  lies  in  folds,  and  a  wound  inflicted  when 
these  parts  were  so  flexed  would  be  irregular,  wavy,  or  zig-zag. 


RELATIVE    POSITIONS    OF    THE    VICTIM    AND    ASSAILANT.    540 

Further,  the  position  and  movement  of  these  parts  necessary 
to  restore  directness  to  the  woun^  niaj^  indicate  the  position 
of  the  parts  when  the  wound  was  inflicted.  The  examination 
of  the  relative  positions  of  the  wound  in  the  clothes  and  the  body 
may  help  to  indicate  the  position  of  the  body  when  wounded. 
The  position  of  the  blood  on  the  body  and  the  direction  of  the 
blood  from  the  wound,  whether  below  or  at  the  sides,  etc., 
tends  to  show  the  position  of  the  body  when  bleeding.  Thus 
if  the  body  was  at  any  time  in  tlie  erect  position,  some  of  the 
blood-stains  will  be  vertically  below  the  wound,  or  if  the  victim 
was  lying  on  the  back  then  the  stain  would  be  at  the  sides  only 
and  not  below  the  wound,  except  such  stains  as  indicate  that 
the}'  were  produced  by  arterial  jets.  Few  suicides  cut  the 
throat  in  the  recumbent  position ;  therefore  it  maj'  be  consid- 
ered in  the  light  of  an  indication  of  homicide  if  the  blood-stains 
show  that  the  victim  was  not  erect  after  the  wound  was  in- 
flicted. It  is  well  also  to  note  the  form,  direction,  and  obliquitj^ 
of  the  blood-spot.  This  would  indicate,  by  comparison  with 
the  wound,  the  relative  position  of  the  wounded  person  and  the 
blood-spot,  and  thus  show  whether  the  body  had  been  moved 
or  not,  as,  for  instance,  b}'  the  murderer  for  the  purpose  of 
robbery.  The  force  of  the  bleeding  is  also  indicated  b}^  the 
form  of  the  spot,  and  this  would  indicate  how  rapidlj^  death 
probably  ensued.  This  fact  might  thus  help  us  to  judge 
whether  the  victim  ];)robably  died  where  he  was  wounded,  and 
whether  other  and  remote  blood -spots  would  not  be  presumptive 
of  murder.  If  the  victim  is  found  in  night-clothes,  this  fact 
would  help  to  show  that  he  was  lying  down  when  wounded. 
The  medical  evidence  as  to  the  position  of  the  victim  when  in- 
jured is,  therefore,  circumstantial  and  not  very  positive ;  that 
in  regard  to  the  relative  position  of  the  victim  and  assailant 
is  even  less  positive.  We  presuppose  in  this  question  that  the 
case  is  one  of  jnurder.  We  are  not  to  prove  murder  or  refute 
suicide.  We  can  rarely  be  positive  as  to  the  relative  position 
of  the  assailed  and  the  assailant.  A  wound  in  the  back  may 
be  caused  by  some  one  in  front  with  an  arm  behind.  The 
direction  of  the  wound  would  indicate  this,  for  if  the  assailant 
is  right-handed  and  inflicts  a  wound  on  the  back  from  in  front, 
a  stab-wound  would  almost  always  be  directed  from  left  to 
r^ght,  an  incised  wound  from  riglit  to  left,   both  from  above 


544  WOUNDS — WOOLSF.Y. 

downward.  With  a  left-handed  murderer  the  direction  would 
most  likely  be  from  right  to  left  and  from  above  downward  for 
a  stab- wound,  and  from  left  to  right  and  from  above  downward 
for  an  incised  wound.  If  the  assailant  were  at  the  back  of  the 
victim  and  wounded  him  in  front,  the  direction  of  these  wounds 
would  be  the  opposite  of  the  above,  i.e.,  from  right  to  left  for 
a  stab- wound  and  from  left  to  right  and  from  above  downward 
for  an  incised  wound  with  a  right-handed  assailant  and  vice 
versa  with  a  left-handed  assailant.  These  wounds  occur  more 
commonlj^  than  those  of  the  back,  and  are  especially  noticeable 
in  incised  wounds  of  the  throat.  In  the  case  of  these  incised 
wounds  of  the  throat  inflicted  from  behind,  the  direction  from 
left  to  right  and  from  above  downward  resembles  that  of  self- 
inflicted  wounds  in  the  same  situation.  As  a  general  rule, 
wounds  are  on  the  same  side  of  the  victim  that  the  assailant 
was;  the  facts  given  above  help  to  show  us  the  exceptions. 
Thus  a  wound  on  one  side  is  presumptive  that  the  murderer  was 
on  that  side,  or  possibly  at  the  front  or  back  and  only  excep- 
tionally on  the  opposite  side.  The  presence  of  wounds  on  one 
side  only  may  help  to  confirm  the  testimony  of  a  witness  that 
the  victim  was  against  a  wall  or  some  other  obstacle  which 
protected  the  other  side.  The  question  of  the  relative  position 
of  the  combatants  in  duels  and  the  nature  of  the  weapons  used 
as  shown  by  the  wounds  has  sometimes  come  up,  especially  in 
other  countries,  to  determine  whether  the  combat  was  regular 
and  fair. 

In  all  cases  of  suspected  suicide,  but  where  a  doubt  exists 
between  suicide  and  murder,  or  even  accident,  hereditary  dis- 
position and  organic  affections  of  the  body,  such  as  alcohol- 
ism, incurable  or  painful  diseases,  chronic  inflammation  of  the 
brain  and  meninges  or  of  the  genito-urinary  organs — all  such 
and  hereditary  predisposition  may  support  the  idea  of  suicide. 

Imputed  or  Self-Inflicted  Wounds. 

Closely  allied  with  the  question  of  the  suicidal  or  homicidal 
origin  of  wounds  is  the  question  whether  a  wound  imputed  to 
another  is  self-inflicted  or  inflicted  by  another.  These  wounds 
are  seldom  fatal.  In  discussing  the  question  whether  a  wound 
is  self-inflicted  or  inflicted  by  another,  we   have  referred  oc- 


IMPUTED    OR    SELF-INFLICTED    WOUNDS.  545 

casionaliy  to  suicidal  wounds  where  the  circumstances  were 
such  as  apparently  purposely  to  imply  murder  and  impute  the 
cause  of  death  to  some  one  else.  This  happens  more  often  in 
cases  of  unsuccessful  suicide.  Here  we  have  recourse  to  the 
same  evidence  that  we  have  gone  over  in  the  present  section 
which  helps  to  distinguish  between  a  suicidal  and  a  homicidal 
wound.  The  case  may  be  somewhat  more  difficult,  as  the 
unsuccessful  suicide  may  manufacture  evidence  against  the 
accused  and  hide  to  some  extent  the  evidence  of  suicide. 
These  cases  can  usually  be  decided,  however,  in  connection 
with  the  circumstantial  and  other  evidence.  The  majority  of 
cases  of  imputed  but  self-inflicted  wounds  are  very  superficial, 
often  not  below  the  true  skin.  Being  self-inflicted  the^"  have 
many  of  the  characters  of  suicidal  wounds.  Thus  they  are 
usually  situated  in  front  and  on  the  left  or  right  according 
as  the  wounded  person  is  right  or  left  handed,  and  the  direc- 
tion is  usually  similar  to  that  in  suicidal  wounds.  Such 
wounds  are  generally  incised  or  punctured  wounds,  seldom  con- 
tused wounds,  and  in  this  respect  they  resemble  suicidal 
wounds.  As  exceptions  to  this  rule,  Bergeret '  mentions  some 
cases  where  females  in  attacks  of  hysteria  have  inflicted  severe 
contusions  on  themselves,  and  have  preferred  charges  of  at- 
tempted murder  against  innocent  persons.  Like  suicides  also 
the  hands  are  seldom  injured,  though  they  may  bo  much  so 
in  resisting  homicide. 

In  other  respects,  however,  these  wounds  dift'er  from  suicidal 
wounds.  .  Thus  they  are  not  usually  situated  over  a  "  mortal" 
spot,  and  they  are  often  numerous  and  scattered,  sometimes 
parallel  and  sometimes  not.  The  wounds  in  the  dress  do  not 
correspond  even  as  often  as  in  suicide.  In  comparing  cuts  in 
clothing  with  those  on  the  body,  it  is  important  to  find  what  ar- 
ticles were  worn  at  the  time  the  assault  was  alleged  to  have  taken 
place,  and  to  make  sure  that  the  clothes  examined  were  those 
worn  or  alleged  to  have  been  worn ,  It  may  not  be  necessary-  that 
the  clothes  examined  should  have  been  really  worn,  for  if  they 
were  alleged  to  have  been  worn  and  were  not,  the  examination  of 
them  will  almost  always  show  the  deception  or  the  self-inflicted 
nature  of  the  wounds.  Then  take  careful  note  of  the  position, 
direction,  form,  and  size  of  the  cut  and  the  apparent  sharpness  of 

'Anu.  d'Hyg.,  1863,  t.  1,  p.  463. 
35 


54G  WOUNDS — WOOLSEY. 

the  weapon  in  the  several  layers,  and  see  if  they  correspond  with 
one  another  and  with  the  wounds  on  the  body  in  those  various 
particulars.  In  imputed  wounds  the  clothes  are  generally  cut 
when  off  the  body  and  can  seldom  be  done  so  as  to  deceive  a 
careful  examiner.  Several  wounds  cannot  exist  in  the  same 
region  of  the  body  without  some  being  bloody  and  showing  the 
marks  of  it  on  the  clothes.  Even  a  single  wound  of  the  clothes 
generally  shows  blood  on  the  inner  surface  if  there  is  a  corre- 
sponding wound  of  the  body  underneath.  In  simulated  and 
imputed  injuries  the  blood-stain  may  be  on  the  outside  of  the 
clothing  instead  of  on  the  inside,  showing  that  it  was  artificial 
and  not  natural.  An  impostor  may  either  do  too  much  or  too 
little,  and  the  medical  witness  should  be  on  guard  against  both 
alternatives.  Taylor  '  mentions  a  case  which  occurred  in  Lon- 
don some  time  ago,  in  which  there  were  two  cuts  in  the  shirt 
near  together  exactly  alike  in  size,  form,  and  direction,  making 
it  evident  that  the  weapon  had  gone  through  a  fold  of  the  shirt. 
This  proved  that  the  shirt  could  not  have  been  worn  at  the  time 
it  was  cut,  for  if  the  shirt  was  folded  while  on  the  body  the 
weapon  must  have  gone  through  the  fold  and  then  through 
another  layer  of  shirt,  making  three  cuts  instead  of  two,  or  five 
instead  of  four,  before  it  could  have  reached  the  body.  This 
and  other  facts  made  self-infliction  of  the  slight  wound  on  the 
chest  probable.  The  same  author  cites  another  case  showing 
the  imperfect  manner  in  which  the  cuts  in  the  clothes  are  made 
in  imputed  wounds,  the  clothes  being  off  the  body  at  the  time. 
The  case  occurred  in  Nottingham  in  1872,  the  accused  being 
charged  with  wounding  the  plaintiff  on  the  highwaj'  bj"  stab- 
bing him  in  the  arm,  though  there  was  no  robbery  or  other 
motive  for  the  act.  The  coat  and  shirt  sleeve  were  found  cut, 
but  there  was  no  corresponding  cut  in  the  lining  of  the  coat 
sleeve.  The  charge  was  clearl}'  false,  and  was  trumped  up  bj' 
the  youth  who  was  the  plaintiff  because  he  wished  to  leave  the 
place  where  he  had  been  sent  for  private  studj'. 

In  examining  a  case  where  the  self-inflicted  nature  of  im- 
puted wounds  is  in  question,  the  following  are  some  of  the 
many  points  to  keep  in  mind  in  the  examination  and  to  be 
ascertained  by  the  examination:  (1)  The  relative  position  of 
the  plaintiff  and  the  assailant  at  the  time  of  the  alleged  attack. 
'  "Med.  Jurisprudence,"  11th  Amer.  Ed.,  1892. 


WAS    A    WOUND    ACCIDENTAL?  547 

This  can  be  compared  with  the  position  as  stated  by  the  phxintiff 
or  other  witnesses.  (2)  The  situation,  direction,  depth,  nature, 
and  number  of  the  wounds.  (3)  The  situation  and  direction 
of  blood-marks  or  wounds  on  the  dress  or  person  of  either  or 
both.  (4)  The  marks  of  blood  and  the  quantity  of  it  at  the 
spot  of  the  alleged  struggle.  (5)  The  signs  of  a  struggle  and 
the  various  other  points  of  circumstantial  evidence  gone  over 
in  considering  suicidal  and  homicidal  wounds. 

Though  a  severe  blow  may  cause  a  slight  mark,  it  does  not 
follow  that  a  slight  mark  implies  a  severe  injury,  else  the  excep- 
tion is  made  the  rule.  The  inconsistency  of  the  story  of  the 
plaintiff  is  generally  so  paflpable  that  imposture  is  evident,  but 
prejudice  and  unjust  suspicion  are  often  excited  against  those 
accused.  Thus  Taylor '  states  that  "  a  strong  suspicion  was 
raised  against  the  then  Duke  of  Cumberland,  in  1810,  in  refer- 
ence *to  the  death  of  Sellis,  when  a  skilful  examination  of  the 
wounds  on  the  deceased  would  have  shown  that  they  might 
have  been  self-inflicted."  The  same  author  also  cites  the  case 
of  M.  Armand,  a  merchant  of  Montpelier,  whoat  Aix  in  March, 
1864,  was  tried  for  an  alleged  murderous  assault  on,  or  imputed 
murderous  strangulation  of,  his  servant.  The  excoriation  on 
the  back  of  the  neck  was  so  slight  as  to  escape  the  observa- 
tion of  some  medical  men,  and  it  was  evidently  self-inflicted, 
either  accidentally  or  purposely,  as  the  facts  showed.  The 
assertions  of  a  number  of  medical  men  were  taken  by  the  court 
to  support  the  servant's  story  to  the  effect  that  his  master  had 
struck  him  a  severe  blow  on  the  back  of  his  neck,  rendering 
him  insensible  for  many  hours  from  concussion  of  the  brain. 
The  evidence  given  chiefly  by  Tardieu  for  the  defence  showed 
the  story  of  the  complainant  to  be  a  fabrication,  and  the  ac- 
cused was  justly  acquitted. 

Was  a  Wound  Accidental? 

In  answering  this  question  we  must  distinguish  accidental 
wounds  from  those  self-inflicted  and  those  inflicted  by  another. 
These  three  classes  comprise  all  wounds.  In  case  of  a  trial  for 
murder  it  may  be  alleged  by  the  defence  that  the  wound  was 
caused  by  accident  or  that  it  was  due  to  suicide  from  a  fall, 
'"Med.  Jurisprudence."  11th  Amer.  Ed..  1892. 


548  WOUNDS — WOOLSEY. 

falls  being  a  common  class  of  accidental  wounds.  So  we  have 
to  judge  between  accident  on  the  one  hand  and  homicide  and 
suicide  on  the  other  hand.  The  question  arises  especially  in 
cases  where  the  injury  causing  death  is  one  commonly  due  to 
accident. 

As  to  the   QUESTION    BETWEEN  ACCIDENTAL  AND   SUICIDAL 

WOUNDS,  they  are  often  easily  distinguished,  especially  if  the 
body  has  not  been  disturbed.  In  suicide  there  is  clear  evidence 
of  design,  and  the  circumstantial  evidence  helps  to  make  the 
case  clear.  It  may  not  always  be  possible  to  decide,  however, 
as  an  accidental  wound  may  sometimes  resemble  a  suicidal  or 
homicidal  one.  Accident  is  often  shown  by  the  nature  of  the 
wound.  Thus  it  is  rare  for  an  accidental  mortal  wound  to  be 
caused  by  a  knife  or  similar  weapon  held  in  the  hand  and  forced 
into  the  body  by  a  fall,  the  blow  of  an  opening  door,  etc.  But 
such  exceptional  cases  have  been  reported.  Incised  and*punc- 
tured  wounds  are,  therefore,  very  rarely  accidental,  and  most 
accidental  wounds  are  contused  wounds  or  contusions. 

Again,  accident  is  often  shown  by  the  situation  of  the 
wound,  which  should  be  on  an  exposed  part  of  the  body  unless 
the  accident  is  due  to  a  fall  from  a  height,  when  the  wound 
may  be  ahnost  anywhere.  But  such  injuries  are  easil}'  shown 
to  be  due  to  falls.  The  fall,  of  course,  may  be  accidental,  sui- 
cidal, or  homicidal.  Some  wounds  in  exposed  parts  forbid  acci- 
dent on  account  of  their  nature,  i.e.,  deep  incised  wounds  of  the 
throat.  If  the  deceased  has  a  life  insurance,  suicide  is  less 
probable,  as  the  insurance  is  not  paid  in  case  of  suicide.  In 
fine,  accidental  wounds  are  distinguished  from  suicidal  by — (1) 
Their  nature;  accidental  wounds  are  almost  always  contused, 
suicidal  very  rarely  so,  only  in  cases  of  lunatics  and  delirious 
persons  and  where  suicide  is  accomplished  by  a  fall.  ('2)  The 
situation  of  the  wound  or  wounds  indicates  their  origin.  We 
have  already  studied  the  situation  of  suicidal  wounds  and  have 
also  seen  that  accidental  wounds  are  only  on  exposed  parts, 
except  when  the  injury  clearly  indicates  a  fall  from  a  height. 
The  evidence  from  the  direction  of  wounds  rarely  applies,  as 
this  is  valuable  only  in  incised  and  punctured  ^vounds,  which 
are  seldom  accidental.  Both  kinds  of  wounds  are  usually  few 
in  number  except  in  case  of  a  fall  from  a  height  or  a  crush, 
though  sometimes  suicidal  wounds  are  multiple. 


WAS    A    WOUND    ACCIDENTAL?  o4y 

The  evidence  from  weapons,  if  there  be  any,  points  strongly 
to  suicide.  The  signs  of  a  struggle  are  hardly  consistent  with 
either  suicide  or  accident.  The  only  case  in  which  they  might 
occur  would  be  where  a  struggle  occurred  to  prevent  a  suicide 
from  throwing  himself  off  a  height  or  .before  a  vehicle  or  rail- 
way train.  In  such  a  case  accident  would  be  excluded  by  the 
signs  of  a  struggle,  and  the  question  would  lie  between  homi- 
cide and  suicide.  The  examination  of  the  clothes  of  the  de- 
ceased would  furnish  no  evidence  unless  some  letter  or  paper 
were  found  stating  the  purpose  of  committing  suicide.  Little 
or  no  evidence  would  be  furnished  b}'  the  position  of  the  body 
when  found  in  cases  which  might  otherwise  be  doubtful.  Or- 
ganic lesions  or  other  facts  predisposing  to  suicide  would  fur- 
nish presumptive  evidence  against  the  wounds  being  accidental. 
Of  all  these  various  points  the  first,  as  to  the  nature  of  the 
wounds,  is  by  itself  the  most  valuable  and  conclusive.  But 
this  gives  us  no  assistance  in  clearing  up  a  case  where  it  is 
doubtful  whether  a  fall  from  a  height  or  a  crush  by  a  vehicle 
or  railway  train  was  accidental  or  suicidal.  Some  of  the  other 
points  mentioned  may  aid  us  in  such  a  case,  and  also  the  fact 
that  such  injuries  are  far  more  often  accidental  than  suicidal. 
But  in  these  cases,  also,  certain  circumstances  may  show  that 
the  fall  was  not  the  result  of  accident. 

Accidental  wounds  are  generally  caused  by  a  fall  or  a  crush, 
and  the  fact  of  their  accidental  character  is  generally  estab- 
lished by  the  circumstances  of  the  event.  Certain  accidental 
wounds  present  characteristics  which  allow  the  true  nature  of 
the  wounds  to  be  determined.  But  in  some  cases  a  suspicion 
may  arise  and  the  question  may  be  asked  as  to  whether  the 
WOUND  WAS  ACCIDENTAL  OR  HOMICIDAL.  For  instance,  if  a 
person  receives  fatal  homicidal  injuries,  and  just  before  or  after 
death  the  body  is  thrown  from  a  height  or  is  run  over  and 
crushed,  it  may  be  hard  to  determine  the  murderous  element 
among  the  many  wounds.  This  is  the  case  if  the  homicidal 
wounds  were  contusions  or  were  caused  by  blunt  instruments, 
but  rarely,  if  ever  so,  if  thej^  are  incised  or  punctured  wounds 
or  both.  But  even  in  the  former  instance,  a  close  examination 
of  the  lesions  and  of  the  locality  of  the  injury  can  often  clear 
up  the  case.  Thus  in  a  case  mentioned  by  Vibert,'  as  cited  by 
'  Vibert :  "  Precis  ile  Med.  Leg. ,  "  ~\l  Ed. .  1890. 


550  WOUNDS — WOOLSEY. 

Hofmann  after  Taylor,  a  woman  was  found  dead  at  the  foot  of 
some  stairs  in  a  cave.  She  had  died  of  a  fracture  of  the  skull 
and  of  the  spine,  produced  by  the  fall.  But  about  four  or  five 
feet  above  the  level  of  the  top  step  there  was  found  on  the  wall 
the  fresh  marks  of  an  arterial  jet  of  blood.  Examination 
showed  a  wound  in  the  right  temporal  region  which  had  opened 
the  temporal  artery,  and  it  was  therefore  thought  that  the 
woman  was  wounded  at  the  top  of  the  stairway  and  then 
thrown  down,  which  was  afterward  proved  to  be  true.  In  an- 
other case,  reported  by  M.  Tourdes,  a  man  knocked  down  and 
killed  by  an  axe,  which  crushed  his  skull  and  caused  the  brain 
to  exude,  was  placed  in  a  road  frequented  at  night  by  heavy 
wagons.  The  head  was  placed  in  the  rut,  but  the  coagulated 
blood  and  brain  formed  a  puddle  which  did  not  appear  on  the 
wheels  or  their  track,  and  no  bloody  furrow  was  caused  by 
their  passage.  The  same  author  mentions  the  case  of  a  woman 
plainly  strangulated  by  the  hands  and  then  thrown  into  the 
ditch  of  the  fortifications  of  Paris. 

It  is  especially  with  regard  to  fractures  of  the  skull  that 
the  question  often  comes  up  as  to  the  accidental  or  homicidal 
nature  of  the  injury,  as  to  whether  it  is  due  to  a  fall  or  a  wound. 
Sometimes  a  depressed  fracture  may  show  the  form  of  the  in- 
strument. An  extensive  comminuted  fracture  of  the  skull  may 
indicate  greater  violence  than  would  be  received  from  a  fall 
from  the  little  height  which  the  circumstances  may  allow.  As 
to  the  slighter  degrees  of  fracture,  the  disposition  of  the  fracture 
itself  often  shows  less  than  the  form  and  site  of  the  ecchymosis, 
the  lesion  of  the  scalp,  and  the  place  and  position  of  the  body 
when  found.  In  such  cases  the  traces  of  a  struggle,  the  exist- 
ence of  other  wounds,  etc.,  may  be  of  great  importance.  In 
distinguishing  between  homicide  and  accident,  as  in  distin- 
guishing between  the  fetter  and  suicide,  the  most  obscure  and 
difficult  cases  are  those  where  the  injury  has  been  caused  by  a 
fall  from  a  height  or  by  a  crush. 

This  is  illustrated  by  the  case  of  Madame  de  Tourville,  which 
is  quoted  by  Taylor.'  She  was  killed  in  July,  1876,  by  a  fall 
from  a  precipice.  Her  husband,  a  lawyer,  was  accused  of  mur- 
der committed  by  pushing  her  over  a  precipice  in  the  Stelvio 
Pass.  The  place  where  her  dead  body  was  found  was  at  a  con- 
'"Med.  Jurisprudence,"  11th  Amer.  Ed.,  1893. 


WAS    A    WOUND    ACCIDENTAL y  551 

siderable  depth  below,  and  the  injury  was  chiefly  in  the  head, 
which  had  been  crushed  by  the  fall.  The  body  showed  no  evi- 
dence of  intentional  violence.  The  prisoner's  guilt  was  estab- 
lished on  the  following  points:  (1)  The  false  and  inconsistent 
statements  made  as  to  the  occurrence;  (2)  the  marks  of  the 
body  having  been  dragged  some  distance  so  that  a  part  of  the 
dress  was  found,  in  a  bloody  condition,  some  way  from  tl:e 
body;  (3)  there  were  marks  of  blood  on  the  prisoner's  hands 
and  clothing.  After  a  long  trial  he  was  convicted,  though  the 
sentence  was  afterward  commuted  to  imprisonment  for  life. 
Of  course,  as  we  have  already  stated,  if  a  person  is  responsible 
for  a  fall  he  is  also  responsible  for  the  results  of  the  fall.  This 
applies  to  many  of  the  contused  injuries  and  deaths  from  falls 
in  prize-fights  and  drunken  brawls. 

We  may  sum  up  the  points  of  evidence  which  help  us  to 
distinguish  between  an  accidental  and  a  homicidal  injury  much 
as  we  did  when  the  question  lay  between  accident  and  suicide. 
(1)  The  evidence  from  the  nature  of  the  wound  is  not  quite  so 
conclusive  as  when  the  question  lies  between  suicide  and  acci- 
dent. For  contusions  and  contused  wounds  are  far  more  often 
homicidal  than  suicidal,  and  accidental  wounds  are  almost 
always  of  this  class.  If,  however,  the  wounds  are  incised  or 
punctured,  this  fact  points  almost  certainly  to  homicide.  (2) 
As  to  situation,  a  homicidal  wound  ma}-  be  situated  almost  any- 
where ;  an  accidental  wound,  except  in  falls  from  a  height,  only 
on  an  exposed  place.  (3)  The  direction  of  the  wound  can  sel- 
dom help  us  in  the  case  of  contused  wounds  which,  practically, 
are  the  on\y  ones  in  question,  though  it  ma}^  possibly  be  incom- 
patible with  accident.  (4)  As  to  the  number  of  wounds,  homi- 
cidal wounds  are  far  more  apt  to  be  multiple  either  in  a  small 
area  or  scattered  in  such  a  way  that  an  accident  could  hardly  ac- 
count for  them  all.  (5)  A  weapon  may  give  evidence  more  often 
here  than  when  suicide  is  in  question,  for  a  weapon  may  be 
used  to  inflict  contused  wounds  which  may  resemble  those  re- 
ceived in  a  fall.  The  evidence  furnished  by  a  weapon  or  blood, 
hair,  etc.,  on  the  weapon,  etc.,  is  strongly  in  favor  of  murder. 
(6)  The  evidence  from  a  struggle  is  also  more  important  be- 
cause it  is  more  often  found.  A  struggle  may  occur  in  homi- 
cide, and  only  in  homicide,  as  a  rule,  so  that  signs  of  a  struggle 
are  strong  evidence  of  murder  and  against  the  idea  of  accident. 


553  WOUNDS — WOOLSEY. 

(7)  The  examination  of  the  clothes  and  body  of  the  deceased 
may  give  valuable  evidence,  showing,  as  it  may,  signs  of  a 
struggle  or  other  marks  of  an  assailant  and  indicating  murder. 

(8)  Examination  of  the  position  and  attitude  of  the  body  and 
of  the  spot  where  it  lay  and  the  ground  around,  may  furnish 
more  or  less  proof  of  murder,  as  in  the  case  quoted  above. 
Thus  the  track  of  the  murderer  may  be  discovered  or  the  body 
may  have  been  interfered  with  and  moved  or  robbed,  all  indi- 
cating homicide. 

In  any  case,  whether  it  is  desired  to  distinguish  accidental 
from  suicidal  or  homicidal  wounds,  those  cases  present  the  most 
difficulty  which  result  from  falls  from  a  height  or  crushes. 
But,  as  the  crse  of  Madame  de  Tourville  shows,  the  above  given 
and  other  circumstances  may  often  show  even  then  that  the  fall 
or  the  crush  was  not  the  result  of  accident. 

Falls  from  a  height  may,  therefore,  be  the  result  of  sui- 
cide, homicide,  or  accident.  The  injuries  are  similar  in  all 
three  cases.  A  fall  of  six  to  eight  metres  causes,  as  a  rule, 
numerous  lesions,  and  shows  such  a  traumatism  that  the  case 
usually  excludes  the  possibility  or,  at  least,  the  probability  that 
the  wounds  resulted  from  blows.  Sometimes,  however,  the 
gravit}^  of  the  lesion  is  not  i)roportional  to  the  height  of  the  fall. 
Thus  Vibert '  relates  the  case  of  a  man,  afterward  emploj'ed 
for  several  years  in  the  Ecole  de  Medicine,  who  jumped  from 
the  top  of  the  column  of  the  Bastile,  a  height  of  fifty  metres. 
He  rebounded  on  to  some  canvas  stretched  at  the  foot  of  the 
monument,  then  fell  to  the  ground,  and  was  able  to  get  up  and 
walk  away.  Curiously  enough,  he  killed  himself  later  by  jump- 
ing from  the  top  of  an  omnibus  in  motion.  In  the  case  of  falls 
from  a  height,  it  is  especially  true  that  with  grave  lesions  in- 
ternally the  skin  may  be  intact  or  only  slightly  ecchymosed  or 
eroded,  or  the  ecchymosis  may  be  only  deeplj'  seated  so  as  not 
to  appear  superficially.  In  the  latter  case,  if  life  had  continued 
the  ecchymosis  might  have  shown  itself  at  some  spot  on  the 
surface  in  a  few  days,  but  these  falls  from  a  height  are  fatal 
as  a  rule.  In  falls  from  a  height,  besides  ecchj'moses,  which 
may  occur  where  there  are  no  other  injuries  or  may  fail  where 
there  are  many  injuries,  the  lesions  consist  of  fractures  of  bones 
and  ruptures  of  internal  organs,  with  or  without  surface 
'  "  Precis  de  Med.  Leg. , "  2d  Ed. ,  1890,  p.  264. 


INJURIES    FROM    A    FALL.  553 

wounds.  The  fractures  may  be  of  a  number  of  bones,  and 
especially  of  those  which  first  touched  the  ground,  though  the 
skull  may  be  fractured  at  some  part  whether  or  not  it  was 
struck»in  the  fall.  These  fractures  are  often  comminuted,  espe- 
cially fractures  of  the  skull  and  pelvis,  and  when  the  fall  is 
from  a  great  height.  Ruptures  of  muscles  may  occur  with  the 
fractures. 

Ruptures  of  internal  organs  are  not  rare  in  such  cases.  Ac- 
cording to  Vibert,'  the  order  of  frequency  of  rupture  of  the 
various  organs  is  as  follows :  liver,  spleen,  kidnej^s,  lungs,  heart, 
stomach,  intestines,  bladder,  brain.  Rupture  of  the  liver  occurs 
especially  on  the  anterior  and  inferior  surfaces  and  the  bleeding 
is  rather  abundant.  The  healthy  spleen  does  not  rupture  read- 
ily, except  from  a  severe  traumatism,  but  if  it  is  hj-pertrophied 
it  may  rupture  spontaneously  from  muscular  violence.  The 
lung  may  be  ruptured  internally  without  showing  the  rupture 
on  the  surface  and  with  the  ribs  intact.  Two  such  cases  are 
mentioned  by  Vibert,^  and  he  refers  to  others  mentioned  by 
Nelaton  and  Holmes.  Rupture  of  the  brain  without  fracture 
of  the  skull  is  ver}"  rare,  though  cases  have  been  observed  and 
reported,  among  others  by  Casper-Liman.  In  falls  from  a 
height  the  rupture  of  the  aorta,  mesentery,  diaphragm,  and 
larynx  have  been  noted.  It  should  be  remembered  in  this  con- 
nection that  rupture  of  the  liver,  intestine,  bladder,  etc.,  may 
be  caused  by  contusions  without  sign  of  violence  externally,  and 
such  cases  cannot,  therefore,  be  attributed  to  falls  unless  there 
are  other  signs  of  the  latter. 

In  crushes  caused  by  a  heavy  vehicle,  the  lesions  resemble 
in  many  respects  those  due  to  a  fall  from  a  height.  Thus  we 
find  fractures  and  internal  ruptures,  but  we  more  often  and 
regularly  find  subcutaneous  ecchymoses  and  ecchymoses  be- 
tween the  muscles.  The  skin  is  often  stripped  up  extensivelj- 
and  the  injuries  are  generally  limited  to  the  region  injured.  It 
is  rare  to  find  that  the  cause  of  the  injury  leaves  no  trace  on 
the  skin,  for  it  usually  gives  the  form  to  the  erosions  or  ecchy- 
moses. Sometimes,  for  instance,  the  marks  of  a  horseshoe  are 
clearly  visible.  Ruptures  of  internal  organs  maj'  occur  here 
too  when  there  are  slight  external  marks  of  violence  or  even 

'"Precis  de  Med.  Leg.,"  2d  Ed.,  -"Precis  de  ]\Ied.   Leg.."  2d  Ed., 

1890.  1890,  1).  246. 


554  WOUNDS — WOOLSEY. 

none  at  all.  Thus  Vibert '  relates  the  case  of  a  man  with  the 
head  crushed,  but  with  no  signs  of  injury  to  the  trunk  save 
a  few  erosions  at  the  level  of  the  sternum,  who  had  not  only 
rupture  of  the  kidneys,  the  liver,  and  the  spleen,  but  also  of 
the  lungs  and  of  the  heart.  In  the  heart  the  apex  was  com- 
pletely detached  and  floating  in  the  pericardium,  which  was 
intact.  There  was  no  fracture  of  the  ribs  nor  subcutaneous 
or  sub-muscular  ecchymoses.  The  age  of  the  subject  was 
thirty-two,  so  that  the  costal  cartilages  were  not  probably  ossi- 
fied, which  may  have  accounted  for  the  absence  of  fracture  of 
the  ribs. 

Crushes  by  the  fall  of  heavy  tveights  resemble  the  latter 
class  of  crushes,  and  differ  from  falls  from  a  height  in  the  fact 
that  the  wounds  are  usually  limited  to  one  region.  The  lesions 
themselves  are  more  or  less  similar.  Similar  internal  lesions 
may  be  caused  by  the  compression  of  the  chest  and  body  by  the 
knee  of  a  murderer,  which  may  occasion  rupture  of  the  internal 
organs,  fractures  of  ribs,  etc.  Thus,  too,  from  the  pressure  of 
a  crowd  the  ribs  may  be  fractured  and  the  lungs  injured.  It  is 
particularly  in  these  cases  of  injury  from  crushes  or  falls  from 
a  height  that  we  may  have  most  difficulty,  as  far  as  the  medical 
evidence  goes,  of  distinguishing  between  accident,  suicide,  and 
murder.  But  the  various  points  and  considerations  mentioned 
above  will  sometimes  enable  the  medical  witness  to  clear  up 
the  case.  In  some  cases  the  non-medical  evidence,  circum- 
stantial and  otherwise,  may  be  suflQcient  of  itself,  or  at  least  in 
conjunction  with  the  medical  evidence. 

In  falls  from  a  less  high  place  the  difficulty  is  somewhat 
different,  for  here  there  may  arise  the  question  between  a  fall 
and  a  contusion  or  contused  wound,  and  the  question  generall}^ 
lies  between  accident  and  murder,  or,  very  rarel}^,  between  ac- 
cident and  suicide.  We  have  referred  to  both  of  these  ques- 
tions above,  and  from  the  facts  mentioned  the  case  can  often 
be  solved. 

Of  more  than  One  Injury  which  was  the  First  In- 
flicted ? 
We  can  sometimes  tell  the  order  in  which  wounds  were  re- 
ceived, but  the  question  is  rarely  answerable  with  certainty, 
'  "Precis  de  Med.  Leg.,"  2d  Ed.,  1890. 


THE   CONSEQUENCES   OF   WOUNDS   NOT   FATAL.  ooJ 

If  one  wound  is  mortal  and  one  or  more  are  not,  whether  the 
wounds  are  suicidal  or  homicidal,  it  has  sometimes  been  con- 
sidered that  the  former  must  have  been  inflicted  last.  But  we 
cannot  admit  that  as  a  general  rule  the  most  grave  wound  was 
the  last  inflicted.  For  the  murderer  or  suicide,  especially  the 
former,  may  go  on  wounding  after  the  infliction  of  a  mortal 
wound,  especially  as  it  is  the  exception,  and  not  the  rule,  to  die 
instantly  after  a  mortal  wound.  Several  assailants  may  have 
inflicted  wounds  at  the  same  time,  which  would  still  further 
increase  the  difficulty.  The  question  might  then  arise.  Which 
assailant  had  inflicted  the  mortal  wound  or  which  had  first 
inflicted  a  mortal  wound?  Under  such  circumstances,  it  would 
not  be  easy  to  give  a  specific  answer.  There  are  several  signs 
which  may  indicate  which  wound  was  first  inflicted  in  certain 
cases.  An  instrument  may  become  duller  or  even  bent  or 
twisted  after  and  on  account  of  the  first  wound,  and  the  subse- 
quent wounds  would  vary  accordingly.  The  wound  of  the 
clothes  corresponding  to  the  first  stab- wound  may  be  and  often 
is  only  bloody  internally,  while  the  second  and  following 
wounds  are  bloody  on  both  sides.  The  following  case  quoted 
by  Taylor  '  from  the  Annales  d  ^Hygiene,  1847,  p.  401,  illustrates 
this  point.  A  man  received  three  stabs  from  an  assailant,  one 
in  the  back  at  the  level  of  the  eighth  rib,  traversing  the  lung 
and  heart  and  causing  rapid  death,  and  two  on  the  left  elbow, 
cutting  the  coat  and  shirt  but  only  grazing  the  skin.  The  first 
one  was  evidently  the  first  inflicted,  for  both  the  wounds  in  the 
clothing  on  the  arm  were  bloody  externally  at  the  edges,  al- 
though there  was  no  blood  effused  here.  The  correctness  of  this 
opinion  was  confirmed  at  the  trial. 

The  point  of  a  knife  arrested  and  broken  off  in  a  bone  may 
show  that  this  was  the  last  wound.  The  amount  of  bleeding 
may  show  which  was  the  first  wound.  Thus  if  several  severe 
wounds  have  been  inflicted,  all  or  several  of  which  would  nat- 
urally cause  profuse  hemorrhage,  and  one  showed  signs  of  such 
hemorrhage  while  another  did  not,  the  former  would  be  likely 
to  be  the  first  wound  inflicted.  Or  if  one  showed  slight  hem- 
orrhage where  much  would  be  expected,  this  fact  would  indicate 
that  it  was  one  of  the  last  inflicted.  The  absence  of  the  signs 
of  spurting  blood  may  tell  which  of  two  or  more  fatal  wounds 
'"Med.  Jurisprudence,"  11th  Amer.  Ed.,  1892. 


556  WOUNDS — WOOLSEY. 

were  first  inflicted,  for  this  would  indicate  that  this  wound  was 
inflicted  when  the  heart  action  was  weakened  by  loss  of  blood 
or  even  after  death,  and  the  other  wound  or  wounds  which  did 
not  present  this  sign  would  have  been  the  first  received.  In 
fact,  if  any  of  the  signs  are  present  about  a  wound  which  we 
have  seen  to  indicate  that  a  wound  was  inflicted  at  any  time 
after  death,  this  would  show  that  this  wound  was  not  the  first 
received,  and  that  the  other  or  others  were  inflicted  earlier. 

Questions  as  to  the  consequences  of  wounds  not  fatal 
may  often  be  brought  up  in  civil  actions  for  damages.  In  cer- 
tain countries  the  question  of  the  consequences  as  to  incapacity 
may  determine  whether  an  injury  shall  be  the  ground  of  a 
criminal  as  well  as  of  a  civil  action.  Thus  in  France  an  injury 
which  involves  an  incapacity  of  twenty  days  or  more  subjects 
the  assailant  to  a  criminal  action.  The  term  "  incapacity"  in 
this  instance  refers  to  general  incapacit}"  and  not  to  incapacity 
for  fine  and  i^rofessional  work.  The  latter,  however,  comes  in 
under  the  civil  action  which  may  be  instituted  against  the  as- 
sailant or  those  directly  or  indirectly  responsible  for  the  injury. 
The  amount  of  the  incapacity,  its  causes,  whether  duewhoUj-  or 
partly  or  not  at  all  to  the  given  injury,  the  probable  duration  of 
the  incapacity,  the  treatment  which  it  has  and  will  necessitate, 
and  many  other  such  questions  form  part  of  the  medical  testi- 
mony required  in  such  cases.  Sometimes  with  slight  wounds 
the  results,  accompaniments,  and  complications  may  prolong 
the  incapacity  very  greatly,  as  also  the  state  of  health  and  the 
habits  of  the  wounded  person,  the  neglect  of  treatment,  improper 
treatment,  etc. 

Any  bodily  or  mental  infirmity  or  ill-health  which  may 
result  from  an  injury  and  its  necessary  treatment  in  the  past 
and  future,  all  these  questions  and  many  more  unnecessary  to 
mention  may  be  required  of  the  medical  witness.  No  general 
rules  can  be  laid  down  for  all  such  cases.  In  giving  his  testi- 
mony the  medical  man  must  depend  in  any  particular  case  upon 
his  knowledge,  judgment,  and  experience. 

We  can  seldom  give  a  precise  solution  of  the  question  of 
sui'vival  to  determine  the  succession  or  inheritance  if  several 
of  a  family  die  together  in  an  accident.  In  case  of  death  from 
inanition,  cold  or  heat,  or  in  drowning  especially,  if  some  have 
wounds  more  or  less  grave  in  themselves,  we  can  sometimes 


INCISED   AND    PUNCTUBED    WOUNDS.  55? 

form  an  opinion.  With  wounds  we  cannot  often  do  so,  al- 
though in  case  of  murder,  the  nature  of  the  wounds,  the  posi- 
tion of  the  bodies,  the  examination  of  the  spot  of  the  accident 
or  tragedy,  may  sometimes  help  us  to  form  an  opinion. 

INCISED     AND     PUNCTURED     WOUNDS     AND     WOUNDS     OF 
BLUNT   INSTRUMENTS   REGIONALLY   CONSIDERED. 

The  several  varieties  of  wounds  which  we  have  been  con- 
sidering vary  considerably  in  their  nature,  their  effects,  their 
danger,  and  in  many  other  ways  according  to  the  region  of  the 
body  in  which  they  are  situated.  Some  of  these  varieties  are 
common  in  one  situation  and  almost  never  occur  in  others. 
Although  the  nature  of  wounds  found  in  the  several  regions  of 
the  body  is  not  as  important  for  a  medical  jurist  as  their  danger 
and  their  influence  in  causing  death,  we  will  now  consider  the 
differences  they  exhibit  on  account  of  the  region  in  which  they 
occur. 

WOUNDS   or   THE   HEAD. 

These  are  often  characterized  by  their  apparent  harmlessness 
and  their  real  gravity  sooner  or  later.  We  might  almost  make 
the  opposite  statement  and  say  that  those  apparently  grave 
are  often  virtually  harmless,  though  this  would  be  true  only  in 
a  limited  sense  and  in  certain  cases. 

As  to  their  nature,  we  find  punctured  wounds  extremely 
rarely,  incised  and  lacerated  wounds  often,  while  contusions 
and  contused  wounds  are  still  more  common.  Incised  and 
lacerated  wounds  of  the  head  involve  the  scalp  almost  exclu- 
sively. These  wounds  heal  remarkably  well,  even  when  the 
attachment  is  merely  by  a  narrow  pedicle,  owing  to  the  abun- 
dant blood-supplj-.  Hemorrhage  from  the  incised  wounds  is 
often  free,  for  the  vessels  cannot  retract,  but  it  is  seldom  dan- 
gerous unless  the  wounds  are  very  extensive.  The  only  way 
in  which  they  differ  materially  from  similar  wounds  elsewhere 
is  in  the  greater  frequency  of  complicating  erysipelas  here  than 
elsewhere.  This  is  probably  owing  to  the  presence  of  septic 
conditions,  as  the  head  is  generally  dirtier  than  other  parts  of 
the  body,  and  slight  wounds  especially  are  neglected.  If  the 
scalp  is  shaved  over  a  wide  margin  and  cleaned  like  other  parts 


558  WOUNDS — WOOLSEY. 

• 

of  the  body,  erysipelas  is  found  little  or  no  oftener  than  with 
similar  wounds  elsewhere.  The  density  of  the  scalp  is  so  great 
that  the  redness  and  swelling  accompanying  intiammations  is 
comparatively  slight.  If  erysipelas  follows  slight  wounds  of 
the  head,  there  is  some  reason  to  suspect  constitutional  predis- 
position or  careless  treatment.  From  infection  of  such  wounds 
of  the  scalp  abscess  or  diffuse  cellulitis  of  the  scalp  may  develop 
as  well  as  erysipelas.  The  constitutional  symptoms  in  such  a 
case  may  be  marked  or  even  severe,  but  the  prognosis  is  favora- 
ble. In  very  rare  cases  necrosis  of  the  skull  may  result  or  the 
inflammation  may  even  extend  to  the  brain.  These  incised  and 
lacerated  wounds  of  the  scalp  are  usually  accidental  or  inflicted 
by  another;  they  are  rarely  self-inflicted.  Contusions  and 
contused  u'ounds  are  the  most  common  forms  of  injury  to  the 
head.  These  two  kinds  of  injuries  are  almost  invariably  in- 
flicted by  another  or  are  accidental.  We  have  already  seen 
that  contused  wounds  of  the  scalp  or  over  the  eyebrow  may 
closely  resemble  incised  wounds  in  these  localities.  This  fact 
should  be  borne  in  mind,  as  careful  examination  can  usually 
distinguish  them  if  they  are  fresh  and  until  they  begin  to  gran- 
ulate. These  wounds  are  liable  to  the  same  complications  as 
incised  wounds,  in  fact  more  liable,  as  the  contusion  makes  the 
wound  more  susceptible  to  inflammation  and  the  edges  are  more 
apt  to  be  infected  at  the  time  of  the  injur}'. 

One  of  the  results  of  contusions  of  the  head  is  the  extrava- 
sation of  blood,  most  often  between  the  aponeurosis  of  the 
occipito-frontalis  inuscle  and  the  pericranium.  These  extrav- 
asations are  usually  in  the  form  of  a  hematoma.  Such  hema- 
tomata  often  present  a  hard  circular  or  oval  rim  with  a  softer 
centre,  and  may  readily  be  mistaken  for  fracture  of  the  skull 
with  depression.  The  diagnosis  between  hematoma  and  de- 
pressed fracture  is  not  usually  difficult,  however,  for  with 
hematoma  the  ridge  is  elevated  above  the  level  of  the  skull  and 
is  movable  on  the  surface  of  the  skull ;  also  the  wounded  edges 
often  pit  on  pressure.  With  depressed  fracture,  on  the  other 
hand,  the  edge  is  at  or  about  the  level  of  the  rest  of  the  skull ; 
it  is  sharper,  more  irregular,  and  less  evenly  circular.  Contu- 
sions and  the  resulting  hematoma  maj'  occasionally  end  by 
suppurating,  but  this  event  is  rare.  Contusions  and  contused 
wounds  may  occasionally  show  the  marks  of  a  weapon,  indicat- 


WOUNDS    OF    THE    HEAD.  559 

ing  that  they  were  inflicted  bj'  another.  Also  the  position  of 
the  injury  will  indicate  its  origin,  whether  it  is  accidental  or 
inflicted  by  another,  for  the  former  would  not  naturally  occur 
on  the  vertex  unless  the  fall  was  from  a  considerable  height. 

Another  result  of  injuries  to  the  head,  especially  of  contu- 
sions and  contused  wounds,  is  fracture  of  the  skull.  This 
ma}'  be  simple  or  compound,  depressed  or  not,  etc.  Fractures 
are  serious  inasmuch  as  they  imply  a  degree  of  violence  which 
may  do  damage  to  the  brain.  The  fracture  itself,  especially  if 
properly  treated,  affords  a  good  prognosis,  irrespective  of  any 
brain  lesion.  One  variety  of  fracture  of  the  skull  ofl^ers  an 
exception  to  this  favorable  prognosis,  and  that  is  fractures  of 
the  base  of  the  skvill.  These  may  be  fatal  directly  from  injur}" 
of  the  vital  centres  at  the  base  of  the  brain  or  soon  fatal  from 
hemorrhage  in  these  parts.  Or  the  fatal  result  may  be  second- 
ar}-  to  an  inflammation  or  meningitis  which  good  treatment  is 
often  unable  to  prevent.  It  should  not  be  considered  that  these 
fractures  are  uniformly  fatal,  for  quite  a  considerable  proportion 
recover.  Fracture  of  the  base  usually  occurs  as  the  result  of 
a  fall.  The  injured  person  may  land  on  the  feet  or  buttocks, 
and  yet  receive  a  fracture  of  the  base  of  the  skull,  the  force  of 
the  fall  being  transmitted  through  the  spine  to  the  base  of  the 
skull.  Fracture  of  the  base  of  the  skull  usually  occurs  from 
an  injury  to  the  vault,  not  by  contre  coup,  but  by  extension  of 
a  fissure  found  higher  up  in  the  skull.  This  extension  takes 
place  in  the  same  meridian  line  of  the  skull  with  that  of  the 
force  which  produced  the  fracture,  and  in  this  waj'  the  base  of 
the  skull  is  fractured  in  different  parts  according  to  the  point 
and  direction  of  the  application  of  the  force.  Thvis  in  case  the 
force  compresses  the  skull  antero-posteriorly  the  fracture  will 
pass  antero-posteriorly  toward  the  base  from  the  front  or  the 
back,  whichever  received  the  blow  (see  Fig.  13).  Fractures  of 
the  vault  of  the  skull  occasionally  occur  opposite  to  the  point 
struck ;  this  may  occur  by  contre  coup,  but  not  always  so,  as 
not  infrequentl}'  in  such  rare  cases  a  close  examination  may  re- 
veal an  extension  of  a  fissure  from  the  point  injured  to  the  oppo- 
site pole  of  the  skull.  The  shape  and  rarely  the  size  of  a  fracture 
of  the  skull,  especially  if  punctured  in  character,  may  show  the 
shape  and  more  rarely  the  size  of  the  instrument  or  object 
which  produced  it.     Apart  from  fracture  of  the  base,  the  prog- 


500 


WOUNDS — AVOOLSEY. 


nosis  in  fracture  of  the  skull  is  serious,  mainly  on  account  of 
the  danger  of  inflammation,  which  is  greater  in  compound  frac- 
tures, and  also  on  account  of  the  more  remote  danger  of  irrita- 
tion from  depressed  fragments  causing  epilepsy,  insanity,  etc., 
at  a  later  period. 

A  circumstance  that  Taylor '  says  is  connected  with  fracture 
of  the  skull  with  depression — namely,  that  the  person,  sensible 
as  long  as  the  object  producing  the  fracture  remained  wedged 


Fig.  13.— Several  Fractures  of  the  Left  Half  of  the  Base  of  the  Skull,  Running  Paral. 
lei  to  One  Another  and  Approaching  One  Another,  also  Separation  of  the  Mastoid  Suture. 
The  injury  was  caused  by  a  fall  on  the  left  side  of  the  back  of  the  head. 

in,  became  insensible  and  began  to  manifest  other  fatal  symp- 
toms as  soon  as  it  was  removed — must  be  extremely  exceptional. 
It  may  be  explained,  if  it  occurs,  by  the  occurrence  of  hem- 
orrhage after  the  object  which  occluded  an  open  vessel  by  its 
presence  or  its  pressure  was  removed.  For  it  should  be  remem- 
bered that  the  symptoms  of  compression  in  a  depressed  fracture 
of  the  skull  are  very  rarely  due  to  the  compressing  effect  of  the 
depressed  bone,  but  rather  to  an  injury  of  the  brain,  intracra- 

'  "Med.  Jurisprudence,"  11th  Amer.  Ed.,  1892,  p.  334. 


CONCUSSION. 


5G1 


nial  hemorrhage,  or  a  local  and  temporary  interference  with  the 
circulation. 

AVe  may  trul}'  say  that  wounds  of  the  head  are  dangerous 
in  proportion  as  thej^  affect  the  hrain.  The  existence  of  affection 
of  the  brain  may  be  hard  to  tell  from 
the  appearances,  for  an  injured  person 
may  recover  from  the  first  effects  of  a 
comparatively  slight  wound  and  yet 
die  suddenly  later. 

Concussion  is  the  name  applied 
to  one  of  the  effects  on  the  brain  of  a 
more  or  less  violent  blow  directlj'  on 
the  head  or  transmitted  indirectly  to 
the  head.     Though  the  term  "  concus- 
sion" implies  a  functional  rather  than 
an  organic  lesion,  yet  in  the  majority 
of  cases  it  is  equivalent  to  laceration 
of  the  brain.     With  laceration  of  the 
brain  there  is  usually  more  or  less  effu- 
sion of  blood  which  may  be  limited  to  a  very  thin  layer.     Con- 
cussion may  exist  without  laceration  of  the  brain.     Even  death 
has  been  known  to  occur  from  concussion  of  the  brain  without 
any  visible  signs  of  injury  to  the  brain,  so  that  the  concussion 


Fig.  14.— "Terraced"  Fracture 
of  the  Left  Parietal  Bor.e  near 
the  Sagittal  Suture,  caused  bj-  the 
Lower  Part  of  the  Kim  of  a  Rouud- 
Headed  Hammer.  The  blow  was 
struck  from  the  right  side.  ]4 
natural  size. 


-^^. 


Fig.  15.— Fractures  of  the  Skull  caused 
by  a  Four-sided  Hammer,  One  caused  by 
tlie  Corner,  the  Other  by  the  End  of  the  Head 
of  the  Hanmier.    14  natural  size. 


Fig.  16.— Four-sided  Fraetiu'e  caused  by 
a  Hatchet-Shaped  Instrument,  the  Edjres 
Formed  by  Depression  of  tlie  Broken  Outer 
Table  of  the  Skull. 


must  have  been  functional  and  the  fatal  result  due  to  shock  of 
the  nervous  system.  Fatal  concussion  does  not,  therefore,  ne- 
cessitate the  existence  of  compression  or  visible  injury  of  the 
brain.     Concussion  may  sometimes  be  due  to  a  violent  fall  upon 

the  feet,  in  which  case  the  shock  is  transmitted  through  the 
36 


562  WOUNDS — WOOLSEY. 

spinal  column  to  the  head  with  or  without  fracture  of  the  base 
of  the  skull.  It  was  in  this  way  that  the  Duke  of  Orleans,  the 
son  of  Louis  Philippe,  died. 

The  symi^toms  of  concussion  show  all  degrees  of  severity'. 
Thus  the  injured  person  may  become  confused  and  giddy  with 
or  without  falling,  he  may  become  pallid  and  nauseated  and 
may  vomit,  but  after  a  short  period  he  recovers  gradually. 

With  a  more  severe  injur}",  with  which  there  is  generally 
some  laceration  of  the  brain,  the  injured  person  falls  and  lies 
quiet  and  relaxed,  apparently  unconscious,  though  often  he  can 
be  partly  roused.     Paralysis  and  anaesthesia  are  absent.     The 


Fig.  17.— Fracture  of  I'arictal  Bone  with  Depression,  caused  by  the  Blow  of  an  Axe. 

heart  is  feeble  and  fluttering,  the  skin  cold  and  clammy.  The 
pupils,  as  a  rule,  react  to  light,  but  otherwise  vary  considerably. 
Urine  and  fseces  may  be  passed  involuntarily.  As  he  begins 
to  regain  consciousness,  vomiting  usually  occurs.  Conscious- 
ness usually  returns  within  twenty-four  or  forty-eight  hours, 
when  headache  and  indisposition  to  exertion  are  complained 
of,  and  this  may  last  for  a  long  time.  Occasionall}"  the  symp- 
toms instead  of  abating  increase,  and  coma  supervenes,  often 
indicating  meningitis,  encephalitis,  or  intracranial  hemorrhage. 
In  other  cases  the  person  irvs.j  die  almost  immediately  on  the 
spot  where  he  fell,  while  in  still  others  apparent  recovery  takes 
place  and  death  occurs  later  either  suddenly  or  after  a  reap- 


ABSCESS    OF    THE    BKAIN. 


563 


pearance  of  symptoms.  In  such  cases,  abscess  of  the  brain 
may  occur  and  be  the  cause  of  the  fatal  result.  These  abscesses 
are  the  result  of  the  injury,  which  may  be  almost  anything 
from  a  compound  fracture  to  a  slight  contusion  not  leaving  any 
scar.  The  abscess  may  occur  within  a  week  *  or  not  until  after 
months  or  years.  This  interval  of  apparent  recovery  may  lead 
to  the  false  supposition  that  death  was  not  due  to  the  injury, 
but  to  some  intervening  cause.  It  is  well  to  bear  in  mind  that 
about  half  of  the  cases  of  abscess  of  the  brain  are  not  trau- 


FiG.  18.— Wounds  of  the  Vault  of  the  Cranium  caused  by  Artillery  Side- Arms,  followed 
by  Death  shortly  after. 


matic.  A  large  majority  of  these  are  due  to  suppuration  in  the 
middle  ear,  a  few  to  septic  diseases  or  tuberculosis.  The  situ- 
ation of  the  abscess  often  distinguishes  between  the  traumatic 
and  non-traumatic  varieties.  The  traumatic  variety  is  usuall}' 
found  beneath  the  injury  or  sometimes  directly  opposite,  where 
the  brain  is  injured  by  a  kind  of  focussing  of  the  radiated  effects 
of  the  blow.  The  cases  of  abscess  of  the  brain  due  to  ear  dis- 
ease are  usually  found  in  the  temporal  lobe  of  the  brain  lying 
over  the  position  of  the  ear  or  in  the  cerebellum  behind  it.  The 
uncertainty  of  the  nature  and  the  extent  of  the  cerebral  injury 
'Londou  Lancet,  1873,  i.,  p.  697. 


564  WOUNDS — WOOLSEY. 

in  so-called  contusion  of  the  brain  renders  it  necessary  to  be 
very  careful  in  giving  a  prognosis.  Any  injury  should  be  con- 
sidered serious  which  has  produced  unconsciousness,  for  such 
an  injury  may  produce  enough  laceration  of  the  brain  to  render 
serious  danger  possible  or  even  probable.  We  have  seen  that 
as  a  rule  the  symptoms  of  concussion  come  on  immediately,  but 
it  is  possible  that  symptoms  at  first  so  slight  as  to  escape  notice 
ma}'  become  serious  in  a  few  hours  or  days.  A  gradual  hemor- 
rhage may  sometimes  account  for  this.  The  knowledge  of 
certain  acts  performed  or  a  conversation  held  at  the  last  mo- 
ment before  the  injury  may  be  retained  after  recovery  from  con- 
cussion of  the  brain.  This  is  not  necessarily  the  case,  for  in- 
stead of  remembering  up  to  the  moment  of  the  injury,  the 
injured  person  may  remember  only  up  to  a  certain  time  shortly 
before,  or  a  part  and  not  everj^thing  may  be  remembered. 

The  diagnosis  of  concussion  of  the  brain  from  alcoholism 
is  sometimes  a  matter  of  medico-legal  interest  or  importance. 
Concussion  may  be  so  slight  as  to  simulate  intoxication.  The 
history  often  clears  the  case  up.  The  history  of  a  blow  or  a  fall 
or  the  presence  of  marks  of  violence  on  the  head  indicates  con- 
cussion, though  the  blow  or  fall  may  not  have  caused  the  symp- 
toms, which  may  be  due  to  alcoholism.  The  odor  of  the  breath 
may  indicate  alcoholism,  but  here  too  we  may  have  both 
present  and  the  concussion  may  be  responsible  for  the  symj)- 
toms.  Or  again  the  alcohol  may  have  been  given  as  a  heart 
stimulant  after  the  accident.  This  combination  often  occurs. 
If  there  is  no  odor  in  the  breath,  the  presumption  is  in  favor 
of  concussion.  As  mistakes  are  still  not  infrequently  made  in 
diagnosis,  those  cases  in  which  there  is  any  ground  for  doubt 
should  be  carefully  watched  for  developments.  In  general,  the 
existence  of  concussion  is  more  often  overlooked  than  the  coex- 
isting alcoholism,  so  that  if  there  is  any  doubt  in  a  given  case 
it  should  be  treated  as  one  of  cerebral  injury-.  The  injury 
which  causes  the  concussion  in  such  cases  is  often  due  to  the 
alcoholism.  We  may  be  able  to  verify  this  supposition  if  the 
injury  is  such  as  would  be  likely  to  be  caused  by  a  fall.  There 
may  be  nothing  found  in  the  brain  after  death  to  distinguish 
between  concussion  and  alcoholism.  A  bruise  on  the  head  only 
indicates  a  probability  of  concussion,  for  the  bruise  and  alco- 
holism may  both  be  present,   the  former  perhaps  due  to  the 


EXTRAVASATION"  OR  EFFUSION  OF  BLOOD.        o65 

latter.     The  presence  of  alcohol  in  the  stomacli  would  indicate 
the  existence  of  alcoholism. 

Another  effect  of  an  injury  which  has  caused  concussion  of 
the  brain  is  an  extravasation  or  effusion  of  blood.  Extrav- 
asation of  blood  in  or  on  the  brain  is  one  of  the  commonest 
causes  of  death  from  injur}"  to  the  head.  It  may  occur  with  or 
without  marks  of  external  injurj^.  A  person  suffering  from 
such  an  extravasation  of  blood  may  recover  from  the  first 
effects  of  the  injury,  and  at  a  varying  time  afterward  the 
symptoms  may  return  and  increase  so  as  to  result  fatally.  In 
such  a  case  the  opening  of  the  bleeding  vessel  may  have  be- 
coine  plugged  until  some  exertion,  emotion,  or  excitement  on 
the  part  of  the  injured  person  has  loosened  the  plug.  A  hemor- 
rhage ma}^  have  ceased  from  partial  sj^ncope  and  return  with  a 
stronger  heart  action  due  j^erhaps  to  the  administration  of  alco- 
hol. This  effusion  may  occur  on  the  surface  of  the  brain  in 
connection  with  a  superficial  laceration  of  the  brain  or  just  be- 
neath or  outside  the  dura  mater  and  not  involving  the  brain 
directly.  The  latter  cases  are  almost  alwaj^s  due  to  the  effects  of 
violence,  though  there  is  at  least  one  case  of  apparently  sponta- 
neous rupture  of  the  middle  meningeal  artery.  The  violence 
which  causes  a  rupture  of  the  branches  of  this  artery  may  be 
so  slight  as  to  leave  no  bruise  or  so  severe  as  to  cause  fracture 
of  the  skull.  The  most  important  symptom  of  such  extradural 
hemorrhage  is  a  period  of  consciousness  after  recovery  from 
the  first  effects  of  the  injury,  then  stupor  ma}-  appear  and  deepen 
into  coma.  A  subdural  hemorrhage  ma}'  cause  almost  the 
same  symptoms,  though  the  injury  is  usually  such  as  has  pro- 
duced a  depressed  fracture.  This  hemorrhage  is  most  often 
due  to  the  rupture  of  a  number  of  small  vessels  under  the  frac- 
ture, though  if  one  larger  vessel  is  rujatured  it  is  most  often  the 
middle  cerebral.  A  thin  layer  of  hemorrhage  in  connection 
with  a  superficial  laceration  of  the  brain  is  of  frequent  occur- 
rence with  or  without  the  other  two  forms  of  intracranial 
hemorrhage.  If  the  brain  is  lacerated  we  may  have  convulsions 
in  addition  to  other  symptoms.  Death  occurring  during  or  soon 
after  a  prize-fight  may  occur  from  some  of  the  above  classes  of 
intracranial  extravasations.  It  ma}^  be  questioned  whether  the 
blows  or  a  fall  caused  the  hemorrhage.  It  is  generally  due  to 
a  fall  in  such  cases,  but  may  be  due  to  blows,  but  tlie  guilt  is 


566  WOUNDS — WOOLSEY. 

the  same  unless  the  fall  was  accidental.  As  the  result  of  severe 
traumatism  the  vessels  of  the  interior  of  the  cerebrum  may  be 
ruptured  or  hemorrhage  may  occur  into  the  ventricles  of  the 
brain.  In  such  cases  the  symptoms  will  resemble  those  of 
ordinary  apoplexy,  only  the  cause  is  different  from  the  latter 
and  the  injury  is  usually  so  severe  as  to  leave  no  doubt  as  to 
the  existence  of  a  traumatism.  The  following  question  may 
arise  in  cases  of  intracranial  hemorrhage  and  especially  in  the 
latter  class  of  such  cases,  i.e.,  in  cerebral  hemorrhage: 

Was  the  Extravasation  of  Blood  due  to  Disease 
OR  Violence? — It  may  be  alleged  in  defence  that  the  hemor- 
rhage was  the  natural  result  of  disease.  Where  the  hemor- 
rhage is  extradural  or  subdural  or  in  connection  with  a  super- 
ficial laceration  of  the  brain,  the  cause  is  almost  always 
traumatic.  We  have  referred  to  one  case  of  extradural  hem- 
orrhage from  spontaneous  rupture  of  the  middle  meningeal 
artery.'  Subdural  hemorrhage  may  occur  from  Pachymen- 
ingitis hcemoi^rhagica  interna,  but  this  condition  is  readily 
diagnosed  on  post-mortem  examination  and  often  with  consid- 
erable certainty  during  life.  A  history  of  alcoholism,  head- 
ache, impaired  intellect,  unsteady  gait,  occasional  losses  of 
consciousness,  stupor  increasing  to  coma,  etc. ,  indicates  such  a 
condition. 

It  is  in  cases  of  cerebral  hemorrhage  that  there  is  the  most 
difficulty  in  discriminating  between  that  due  to  disease  and 
that  due  to  injury.  It  may  be  alleged  that  the  hemorrhage 
was  from  diseased  vessels,  or  that  the  effects  of  a  blow,  which 
cannot  be  denied,  were  aggravated  by  disease  of  the  cerebral 
vessels  or  by  excitement  due  to  intoxication  or  passion.  Cere- 
bral hemorrhage  from  disease  is  rare  before  40  j^ears  of  age, 
except  in  alcoholics.  When  the  hemorrhage  is  due  to  disease 
the  blood-vessels  are  diseased.  The  most  frequent  site  of  such 
hemorrhages  is  the  course  of  the  lenticulo-striate  artery  in  the 
ganglia  of  the  base  or  the  white  substance  of  the  centrum 
ovale. 

When  injury  is  the  cause  of  the  hemorrhage  it  is  usually 

found  beneath  the  point  injured  or  directlj^  opposite  to  this. 

External  signs  of  the  blow  are  generally  visible  if  it  be  severe 

enough  to  cause  a  cerebral  hemorrhage.     The  vessels  may  be 

'  "An  American  Text-Book  of  Surgery, "  p.  496. 


WAS  EXTRAVASATION  OF  BLOOD  DUE  TO  VIOLENCE?        567 

perfectly  healthy  and  the  victim  (^uite  young  if  the  hemorrhage 
is  due  to  an  injury,  also  the  ruptured  vessels  may  be  jjlainly 
torn.  The  most  difficult  cases  are  those  where  there  is  the 
history  of  an  injury  and  at  the  same  time  such  a  condition  of 
disease  of  the  cerebral  vessels,  etc.,  as  would  account  for  spon- 
taneous hemorrhage.  Where  the  injury  was  slight  in  the  case 
of  alcoholics  or  aged  people  the  medical  witness  should  be 
especially  careful  in  stating  that  a  cerebral  hemorrhage  was 
due  to  the  injury.  Then,  too,  in  the  act  of  falling  from  the 
occurrence  of  a  cerebral  hemorrhage  due  to  disease  the  head 
may  be  injured  and  show  marks  of  violence.  It  should  bo 
borne  in  mind  that  an  injury  to  the  head  may  be  inflicted  when 
disease  of  the  brain,  vessels,  or  membranes  already  exists.  In 
such  a  case  a  slight  blow  might  cause  extensive  hemorrhage, 
but  as  that  which  accelerates  causes,  death,  even  though  it 
might  sooner  or  later  have  occurred  in  the  same  manner  with- 
out injury,  is  due  to  the  injury  inflicted. 

From  the  above  considerations  we  see  that  spontaneous 
cerebral  hemorrhage  and  that  due  to  disease  are  not  always 
easily  distinguished  from  that  due  to  violence.  In  severe  in- 
juries the  structure  of  the  brain  is  plainly  bruised,  etc.,  but  the 
greatest  difficulty  exists  in  cases  of  slight  violence  where 
arteritis  of  the  cerebral  blood-vessels  coexists.  The  spontaneous 
extravasation  of  blood  in  or  upon  the  brain  from  excitement 
does  not  usually  occur  except  with  diseased  vessels,  old  age,  or 
alcoholism.  It  is  rare,  therefore,  in  the  young  and  healthy. 
If  there  is  any  doubt  as  to  the  origin  of  the  hemorrhage,  the 
medical  witness  should  state  the  cause  most  probable  in  his 
judgment.  Taylor '  supposes  the  case  of  a  man  excited  by  pas- 
sion, alcohol,  or  both,  who  becomes  insensible  and  dies  after 
being  struck  a  blow  so  slight  that  it  would  not  have  affected  a 
healthy  person.  If  examination  reveals  a  quantity  of  blood 
effused  into  the  substance  of  the  brain,  there  can  be  little  doubt 
in  the  mind  of  the  medical  man  that  the  excitement  was  the 
principal  cause  of  the  effusion.  On  the  other  hand,  if  a  severe 
blow  or  a  violent  fall  on  the  head  had  been  received  in  a  per- 
sonal conflict  with  another  and  it  is  found  that  death  was  due 
to  an  effusion  of  blood  upon  the  surface,  there  can  be  little 
doubt  in  the  mind  of  the  medical  examiner  that  death  was  due 
'"Med.  Jurisprudence,"  11th  Amer.  Ed.,  18fl2. 


568  WOUNDS — WOOLSEY. 

to  the  blow,  which  would  satisfactorily  account  for  the  condi- 
tions found  without  reference  to  coexisting  excitement,  etc. 
In  fact,  in  all  cases  where  a  question  is  raised  as  to  the  cause 
of  the  hemorrhage,  it  is  most  important  to  consider  whether  the 
violence  was  not  sufficient  to  account  for  the  hemorrhage  with- 
out the  coexistence  of  disease  or  excitement.  It  is  also  most 
important  to  bear  in  mind  that  after  severe  injuries,  as  after  a 
fall,  causing  extensive  fracture  of  the  skull,  followed  or  not 
with  extravasation  of  blood,  the  injured  person  may  walk  about 
and  die  some  distance  from  the  place  of  the  accident  and  where 
no  chance  for  a  similar  accident  exists.  In  this  way  the 
suspicion  of  murder  may  be  occasioned,  as  illustrated  in  the  fol- 
lowing case  cited  by  Ta3dor :  ^  A  man  was  accused  of  the 
murder  of  his  cbmiDanion,  who  was  found  dead  in  a  stable  with 
fracture  of  the  temporal  bone  which  had  caused  rupture  of  the 
middle  meningeal  artery.  The  accused  stated  that  the  deceased 
had  been  injured  b}^  falling  from  his  horse  the  day  before. 
After  the  fall,  however,  the  deceased  had  gone  into  a  public- 
house,  where  he  remained  some  time  drinking  before  returning 
to  the  stable.  The  extravasation  had  here  taken  place  gradu- 
all}',  as  is  characteristic  of  hemorrhage  from  the  middle  menin- 
geal artery,  and  perhaps  the  excitement  due  to  the  drinking 
had  influenced  it. 

The  date  of  an  effusion  op  blood  may  sometimes 
be  a  matter  of  importance  in  determining  whether  a  given  ex- 
travasation of  blood  in  or  on  the  brain  w^as  caused  by  a  recent 
blow  or  had  existed  previoush*.  The  color  and  consistence  of 
these  effusions  indicate  whether  the}'  are  old  or  recent ;  the  pre- 
cise date  we  cannot  state,  but  the  information  we  can  give  is 
often  all  that  is  required.  The  color  of  recent  effusions  is  red, 
which  changes  after  some  daj's  to  a  chocolate  or  brown,  which 
generally  turns  to  an  ochre  color  (see  Plate  I.).  This  latter 
color  may  be  met  with  from  twelve  to  twenty-  five  days  after 
the  injury.  The  consistence  of  the  coagula  also  becomes  firmer 
with  age,  and  as  the  coagula  become  firmer  they  are  more  or 
less  laminated  and  the  expressed  lymph  may  lie  between  the 
laminae  or  around  the  coagula. 

On  account  of  the  many  laj^ers  of  the  brain  coverings,  a 
rough  diagram  of  the  coverings  as  given  bj'  Taj-lor  '  may  be  of 
'"Med.  Jurisprudence,"  11th  Amer.   Ed.,  1892. 


MEDICAL  JURISPRUDENCE— PLATE  I. 


Extravasations  in  several  portions  of  the  Arachnoid,  with  hemorrhages  in  neighboring 

PORTIONS  OF  the  BRAIN.     DEATH  IN  FOUR  DAYS. 


Cerebral  abscess.    Epilepsy,  Paresis.    Death  3m  years  after  the  injury. 


RECENT  AND  OLD  CEREBRAL  EFFUSIONS. 


ilkelmtLilJioColl.?. 


WOUNDS    OF    THE    BKAIX    AND    FACE. 


5G9 


Fig.  19.— Diagramalie  Repre- 
sentation of  the  Skull  and  IMem- 
branes  of  the  Brain  for  Exhilii- 
tion  in  Court,  a.  Skull  with 
outer  and  inner  tables  and  dip- 
loe ;  6,  dura  mater ;  c,  arachnoid 
membrane ;    d,  pia  mater. 


much  use  to  the  medical  expert  in  ilhistrating  his  evidence  so 
as  to  make  it  clear  to  the  court  (see  Fig.  19). 

Wounds  of  the  brain  vary  very  widely  in  their  imme- 
diate results  according  to  the  part  of  the  brain  injured.     Thus 
sometimes  a  slight  wound  of  the  brain  may  be  instantly  fatal 
and  often  a  severe  wound  in  another 
part  is  not  so.    Extensive  wounds  may 
occur  especially  in  the  frontal   lobes 
with   remarkably   slight  disturbance. 
If  a  person  with  a  wound  of  the  brain 
survives  the  first  effects  of  the  injury 
the  danger  of  inflammation  remains. 
This  danger  may  not  be  removed  for 
a  long  time,  for  the  inflammation  may 
develop    very    slowl}',     not     showing 
itself   for  "from  throe  to  ten  weeks  or 
even    later.     Thus   Taylor '    cites   the 

case  of  a  child  who  was  accidentally  shot  through  the  brain. 
The  symptoms  of  inflammation  did  not  appear  until  the  twenty- 
sixth  day  and  death  occurred  on  the  twenty-ninth  da3\ 

Wounds  of  the  face  heal  remarkably  well  on  account  of 
its  great  vascularity.  If  severe  they  may  leave  great  deformity 
or  disfigurement,  which  may  be  the  ground  of  a  civil  suit  and 
thus  require  the  testimony  of  a  medical  expert.  If  the  wound 
involves  the  orbit  or  its  contents  it  ma}^  be  more  serious,  either 
from  a  fracture  of  the  thin  upper  or  inner  wall  of  the  orbit, 
separating  it  from  the  brain,  or  from  extension  of  a  secondar}- 
inflammation  of  the  contents  of  the  orbit  to  the  brain.  Wounds 
of  the  eyebrow  may  cause  supraorbital  neuralgia  or  amaurosis 
from  paralysis  of  the  upper  lid.  Some  fractures  of  the  nose, 
especially  those  due  to  severe  injur}'  near  the  root  of  the  nose, 
maj'  be  more  serious  than  they  appear.  For  in  such  cases,  of 
Avhich  the  writer  has  seen  several,  the  fracture  is  not  confined 
to  the  nose,  but  involves  also  the  ethmoid  bone  and  its  cribriform 
plate  forming  part  of  the  base  of  the  skull.  In  such  a  case  a 
fatal  meningitis  is  a  common  result. 

Wounds  of  the  neck  are  verj"  rarely  accidental,  more 
often  homicidal,  but  most  often  suicidal.      In  nature  they  are 
most  often  incised  wounds.     As  we  have  alread}'  seen,  the  kind 
'"Meil.  Jurispviulence,"  1 1th  Amer.  Ed. .  1892. 


570 


WOUNDS — WOOLSEY, 


■%>,. 


-# 


V: 


and  condition  of  the  weapon  used  is  often  indicated  by  the 
character  of  the  wound.  We  have  also  seen  that  in  many  cases 
a  suicidal  wound  of  the  neck  can  be  distinguished  from  a 
homicidal  one  with  more  or  less  probability  or  even  certainty. 
Wounds  of  the  neck  are  often  dangerous,  and  they  may  be 
rapidly   fatal  if  they  divide  the  main  vessels,  especially  the 

carotid  arteries.  Wounds  of  the 
larynx,  trachea,  and  oesophagus  are 
grave  and  often  fatal  from  entrance 
of  blood  into  the  air-passages  or 
from  subsequent  oedema  or  inflam- 
J^,  mation  occluding  the  air-passages. 
Wounds  of  the  sympathetic  and 
pneumogastric  nerves  may  be  fatal, 
and  those  of  the  recurrent  laryngeal 
nerves  cause  aphonia.  The  situa- 
tion of  the  average  suicidal  or  homi- 
cidal cut-throat  wound  is  in  front, 
generally  across  the  thyro-hyoid 
membrane,  sometimes  dividing  the 
cricoid-thyroid  membrane,  and  not 
at  the  side  of  the  neck  where  the 
great  vessels  lie  and  would  be  more 
easily  divided.  The  force  is  ex- 
pended, as  a  rule,  before  the  great 
vessels  are  reached.  The  epiglottis 
may  be  cut  or  detached  and  the  in- 
cision may  even  reach  the  posterior 
wall  of  the  pharynx,  but  the  ma- 

Thyroid  and  Cricoid  Cartilages  of  the  jority  of  the  Suicidal  CaSCS  rCCOVCr 
Larynx,  from  the  Blow  of  a  Plat- Iron.         . ,  i  ,  ,  i.        nm        i  • 

r  With  proper  treatment,      i  he  homi- 

cidal cases  are  more  often  fatal  from  division  of  the  great  ves- 
sels, though,  as-already  stated,  in  either  class  of  cases  a  fatal 
result  may  occur  if  the  air-passages  are  opened  from  the  en- 
trance of  blood  into  them  and  the  consequent  asphyxia. 

Contusions  of  the  neck  may  be  so  severe  as  to  cause  un- 
consciousness or  even  death.  The  latter  may  be  due  to  a 
reflex  inhibitory  action,  as  in  cases  of  death  from  a  blow  upon 
the  pit  of  the  stomach.  As  a  result  of  such  contusions  we  may 
have  a  fracture  of  the  larynx  usually  confined  to  the  thyroid 


V- 


Fig.  20.— Double  Fracture   of  the 


CONTUSIONS   OF   THE   NECK,  571 

and  cricoid  cartilages  (see  Fig.  20).  This  may  be  followed  by 
hemorrhage  from  the  larynx,  some  of  which  may  pass  down  into 
the  trachea  and  threaten  death  from  asphyxia.  Later  emphy- 
sema often  develops  throughout  the  tissues  of  the  neck,  and  there 
is  great  danger  of  oedema  of  the  larynx.  The  prognosis  is 
serious  unless  tracheotomy  is  performed  early  or  the  case  is 
closely  watched.  It  is  most  serious  where  the  cricoid  cartilage 
had  been  fractured,  as  this  requires  a  greater  degree  of  violence. 
Whereas  incised  wounds  of  the  throat  are  most  often  suicidal, 
contusions  are  most  often  accidental  or  inflicted  by  another. 
Among  the  latter  class  of  injuries  may  be  included  the  so-called 
garroting,  by  which  a  person  is  seized  violently  around  the 
throat,  usually  from  behind,  and  generally  with  a  view  to 
strangle  and  rob.  In  such  cases  the  larynx  or  trachea  may  be 
injured  in  the  same  way  as  by  a  contusing  blow. 

WOUNDS  AND  INJURIES  OF  THE  SPINE  AND  SPINAL  CORD. 

Injuries  of  the  spine  resemble  more  or  less  closely  those  of 
the  head.  Fractures  op  the  spine  generally  occur  in  com- 
bination with  dislocation,  as  fracture-dislocation.  Thus  dis- 
placement is  generally  present  and  causes  a  fatal  compression 
or  crushing  of  the  cord.  When  the  cord  has  once  been  crushed 
at  the  site  of  the  displacement  of  the  fracture-dislocation  there 
is  no  hope  of  its  ever  healing.  Therefore  the  lower  end  of  the 
cord  is  never  again  in  functional  connection  with  the  brain. 
These  injuries  are  more  rapidly  fatal  the  higher  up  they  are. 
If  the  injury  is  above  the  fourth  cervical  vertebra  death  is 
nearly  immediate,  for  then  even  diaphragmatic  breathing  is 
impossible,  and  the  injured  person  dies  of  asphyxia.  Fracture 
of  the  odontoid  process  of  the  axis,  which  .regularly  occurs  in 
hanging,  may  occur  from  falls  on  the  head,  etc.,  and  is  not 
alwaj's  immediately  fatal.  Thus  in  one  case*  the  person  lived 
fifteen  months  and  in  another  case  sixteen  months.  In  the 
latter  case  the  fracture  was  due  to  the  patient  turning  in  bed 
while  his  head  was  pressed  on  the  pillow.  In  some  cases  it 
may  be  questioned  how  far  this  injury  may  result  from  disease 
of  the  bones  or  ligaments.  Therefore  a  careful  examination  of 
these  parts  should  be  made  after  death,  which  will  usuallj" 
'Edin.  Med.  and  Surg.  Jour.,  Oct.,  1845,  p.  527. 


572  AVOUNDS— WOOLSEY. 

enable  us  to  answer  this  question,  which  may  be  brought  up  by 
the  defence.  It  is  hardly  necessary  for  our  purpose  to  enumer- 
ate the  symptoms  of  fracture-dislocation  of  the  spine.  Of 
course  the  patients  are  almost  always  unable  to  walk  and  so 
are  bed-ridden.  A  marked  feature  of  fracture-dislocation  of 
the  spine  is  the  length  of  time  intervening  between  the  injury 
and  the  fatal  termination,  and  yet  the  injury  is  wholly  respon- 
sible for  the  death  of  the  injured  person.  This  delay  may 
last  for  months  or  even  for  years  with  careful  treatment.  But 
sooner  or  later  the  case  generally  ends  fatally,  though  not 
necessarily  so.  Where  the  cord  has  been  entireh'  crushed  the 
result  is  almost  alwaj's  fatal ;  where  the  cord  is  not  so  injured 
recovery  may  and  often  does  occur.  According  to  Lutaud,' 
fractures  of  the  spine  are  sometimes  followed  by  secondary' 
paralysis  coming  on  after  healing  of  the  fracture.  At  the  out- 
set we  can  seldom  give  a  de^nite  prognosis,  which  can  onlj-  bo 
given  after  watching  the  developments  of  the  case.  The  prog- 
nosis is  more  favorable  in  fracture  of  the  arches  alone  or  when 
the  injury  is  in  the  lower  part  of  the  spine  and  not  very  severe. 
The  commonest  cause  of  fracture-dislocation  of  the  spine  is 
forced  flexion  of  the  spinal  column.  Injuries  to  the  spine  are 
generally  the  result  of  falls  or  blows  on  the  spine,  especial!}"  in 
its  lower  part.  Lutaud  ^  states  that  after  forced  flexion  of  the 
spine  without  fracture  paraplegia  may  sometimes  occur,  which 
is  attributed  to  forced  elongation  of  the  cord.  This  paraplegia, 
which  may  seem  to  be  grave,  is  completelj^  recovered  from  as 
a  rule. 

Incised  or  punctured  wounds  of  the  spinal  cord  are  rare,  as 
it  is  so  well  protected  except  in  the  very  highest  part  behind. 
Here  between  the  occiput  and  the  atlas  and  between  the  latter 
and  the  axis,  and  to  a  less  extent  between  the  axis  and  the  third 
cervical  vertebra,  the  cord  is  more  exposed,  owing  to  the  nar- 
rowness of  the  laminae.  It  is  here  that  pithing  is  done,  which 
is  almost  instantly  fatal,  as  the  medulla  oblongata  and  upper 
part  of  the  spinal  cord  are  the  parts  injured,  and  they  con- 
tain the  respirator}'  and  other  vital  centres.  Pithing  may 
be  done  with  such  a  small  needle-like  instrument  as  to  leave 
scarcely  sinj  trace.  Only  a  slightly  bloody  streak  may  persist, 
which  may' appear  superficial  if  the  instrument  is  introduced 
'."Manuel  de  Med.  Leg.,"  5th  Ed.,  1892. 


WOUNDS    OF    THE    SPINE    AND    SPINAL    CORD.  573 

obliquely.  Such  a  mark  in  this  location  with  no  other  apparent 
cause  of  death  should  always  lead  to  an  examination  of  the  upper 
part  of  the  cord,  which  will  always  reveal  the  cause  of  death 
in  such  cases.     Pithing  is  practised  especially  in  infanticide. 

As  with  the  brain,  so  with  the  spinal  cord,  we  ma}^  have 
CONCUSSION  due  to  the  shock  of  a  contusing  blow.  Concussion 
of  the  spinal  cord,  as  of  the  brain,  may  be  fatal  without  showing 
scarcely  a  mark  of  violence  externally  or  internally.  As  the 
cord  is  so  well  protected  from  injury,  it  must  be  extremely  rare 
to  have  concussion  of  the  cord  without  some  actual  lesion  of  its 
substance.  As  concussion  of  the  cord  is  not  often  the  result  of 
the  injuries  of  which  we  are  treating,  but  rather  of  railroad 
injuries  and  the  like,  it  will  not  be  considered  at  length  in  this 
connection.  As  a  result  of  a  blow  or  fall  on  the  spine  or  com- 
municated to  it,  hemorrhage  may  occur  in  the  substance  of  the 
cord  or  around  it  between  or  outside  its  membranes.  In  very 
rare  cases  such  a  hemorrhage  may  occur  spontaneousl}'  as  the 
result  of  disease,  of  which  the  writer  has  seen  one  case.  It 
may  be  associated  with  concussion  or  laceration  of  the  cord. 
It  may  destroy  life  directly  by  extension  or  indirectly  by  lead- 
ing to  a  spreading  inflammation.  Hemorrhage  in  or  about 
the  cord  causes  a  gradual  compression  of  the  cord,  and  in  cases 
of  fracture  of  the  spine  often  adds  to  the  compression  due  to 
the  displacement  of  the  bones.  In  hemorrhage  into  the  sub- 
stance of  the  cord  paralysis  comes  on  early  or  immediately  and 
may  be  complete  while  symptoms  of  irritation  fail.  The  latter 
sj'^mptoms  are  most  marked  in  meningeal  hemorrhage  in  which 
paralysis  is  delayed  in  appearance  and  generally  incomplete. 
The  products  of  an  inflammation  due  to  an  injury  may  com- 
press the  spinal  cord  in  the  same  way  that  hemorrhage  does. 

Wounds  and  injuries  of  the  varieties  we  are  considering, 
affecting  the  spine  and  spinal  cord,  are  generally  accidental,  less 
often  homicidal,  and  almost  never  suicidal.  * 

WOUNDS  OF  THE  THORAX  AND  THORACIC  ORGANS. 

Wounds  of  the  thorax  caused  by  incising,  punctur- 
ing, or  blunt  instruments.  These  wounds  are  most  often 
punctured  wounds;  contused  wounds  are  common 'and  incised 
wounds  are  not  rare.     They  are  perhaps  most  often  homicidal 


574  WOUNDS— WOOLSEY. 

in  origin  or  at  least  inflicted  by  another,  and  the  accidental 
origin  of  these  wounds  is  probably  the  least  common. 

Incised  or  punctured  non-penetrating  wounds  of  the  thoracic 
wall  are  rarely  grave.  Bleeding,  as  a  rule,  is  not  serious, 
though  it  may  be  quite  free.  Such  wounds  may  be  accompa- 
nied by  emphysema,  though  not  penetrating,  owing  to  the 
movements  of  the  chest  and  a  valve-like  action  of  the  edges  of 
the  wound.  Contused  wounds  of  the  thorax  are  more  danger- 
ous, especially  if  the  violence  was  great,  owing  to  the  compli- 
cating fracture  of  the  ribs,  rupture  of  the  thoracic  viscera,  etc. 

Fracture  of  the  ribs  is  a' common  result  of  contusions 
of  the  chest.  It  is  more  dangerous  when  due  to  a  direct  blow 
or  injury,  as  then  the  splintering  occurs  internally  and  may 
wound  the  lungs,  heart,  or  large  vessels,  while  with  fracture 
from  indirect  violence,  from  compression  of  the  chest,  the 
splintering  of  the  ribs  occurs  externally.  Fracture  of  the 
upper  ribs  requires  more  force  than  that  required  to  fracture 
the  lower  ones,  and  consequently  the  former  is  the  more  dan- 
gerous. The  diagnosis  of  fracture  of  the  ribs  is  generally  quite 
easy  by  means  of  crepitus  felt  or  heard,  false  motion,  local  ten- 
derness, etc.  Fracture  of  the  sternum  may  be  serious  if 
depressed  on  account  of  the  wounding  of  the  viscera  behind  it. 
Devergie '  cites  such  a  case  where  the  depressed  portion  of  the 
sternum  produced  a  transverse  non-penetrating  wound  of  the 
heart  about  an  inch  in  length,  which  had  caused  death  in 
thirteen  days.  Simple  fracture  of  the  sternum  without  dis- 
placement of  the  fragments  is  rarely  serious  unless  injury  of 
the  thoracic  viscera  is  produced  by  the  same  violence.  Wounds 
or  injuries  of  the  thorax  are  grave  or  not  according  as  they 
penetrate  or  injure  the  thoracic  viscera  or  do  not  do  so.  A 
wound  may  just  penetrate  the  thoracic  wall  without  wounding 
the  thoracic  viscera,  and  is  then  serious  as  a  rule  only  when 
followed  by  inflammation.  In  fact,  many  of  the  penetrating 
wounds  of  the  thorax  wounding  the  viscera  are  onh^  grave  on 
account  of  consecutive  inflammation.  We  have  alread}'  seen 
that  various  characteristics  of  wounds  of  the  thorax,  especially 
of  stab- wounds,  enable  us  to  determine  the  kind  of  weapon  used, 
its  size,  sharpness,  etc.,  and  sometimes  to  identify  the  weapon 
itself.  In  much  the  same  way  we  can  often  determine  whether 
i"Med.  Leg.,"  t.  2,  p.  343. 


WOUNDS   OF   THE   LUNGS.  575 

the  wound  was  suicidally  or  homicidally  inflicted.  The  cause 
of  death  in  wounds  of  the  thorax  may  be  directly  due  to  the 
wounding  of  one  or  more  of  the  thoracic  viscera,  or  it  ma}'  be 
due  to  the  inflammation  occasioned  b}'  it.  Wounds  of  the 
lower  part  of  the  thorax  may  involve  at  the  same  time  the 
thoracic  cavity  proper  and  its  contained  viscera,  the  diaphragm 
9nd  the  abdomen  and  its  viscera.  This  is  the  order  in  which 
the  different  parts  would  be  met  with  in  a  Avound  from  behind 
forward ;  the  order  might  be  the  reverse  of  this  in  a  wound 
from  before  backward.  Penetrating  wounds  of  the  thorax 
may  involve  the  lungs,  heart,  or  great  blood-vessels.  Of  these, 
the  lungs  are  most  often  injured,  which  is  easily  accounted  for 
b}"  the  greater  size  of  the  lungs.  In  wounds  of  the  lungs 
the  immediate  danger  is  from  hemorrhage.  The  hemorrhage 
appears  externally  through  the  wound  and  from  the  mouth, 
being  coughed  up.  Where  the  lungs  are  injured  by  a  blow, 
fall,  or  crush  without  external  injury,  blood  appears  in  the 
mouth  only.  The  blood  coughed  up  from  the  lungs  is  bright 
red  and  frothy,  and  it  ma}-  also  be  frothy  at  the  external 
wound.  Hemorrhage  from  the  external  wound  may  be  slight, 
especially  if  the  wound  is  oblique  and  acts  as  a  valve.  In 
wounds  of  the  lungs  most  of  the  blood  may  collect  in  the  pleura 
or  in  the  lungs,  and  thus,  b}-  compression  from  without  or  by 
displacement  by  the  blood  within  it,  prevents  air  from  entering 
the  lungs  and  produces  asphyxia,  which  may  be  fatal.  More 
or  less  dyspnoea  usually  occurs  at  first.  Emphysema  is  gen- 
erally present  in  the  cellular  tissues,  but  this  latter  symptom 
may  also  occur  at  times  with  non-penetrating  wounds  of  the 
chest.  If  death  does  not  occur  speedily  from  hemorrhage  by 
compression  of  the  lungs  or  heart,  there  are  good  hopes  of 
saving  the  patient,  but  the  prognosis  should  be  reserved. 
For  even  when  the  first  effects  of  the  wound  of  the  lung  are 
survived,  the  patient  may  die  from  the  effects  of  inflammation, 
recurring  hemorrhage,  or  a  too  sudden  relaxation  of  regimen. 
Thus,  for  instance,  if  too  much  food,  talking,  or  exertion  are 
indulged  in  the  case  may  on  this  account  terminate  fatally,  and 
such  aggravating  causes  of  death  may  mitigate  the  sentence. 

Wounds  of  the  heart  are  among  the  most  fatal.  Al- 
though it  was  once  considered,  and  is  usually  thought  now  by 
laymen,  that  wounds  of  the  heart  must  be  necessarily  and  in- 


576  WOUNDS — WOOLSEY. 

stantly  fatal,  the  facts  are  otherwise.  If  the  wound  is  small 
and  obli(iue  life  may  bo  prolonged,  and  cases  are  recorded '  in 
which  wounds  of  the  heart  were  not  directly  fatal,  and  in  some 
of  which  recovery  would  have  probably  resulted  if  not  for  other 
diseases.  Cases  in  which  the  heart  wall  was  wounded  but  not 
penetrated,  and  in  which  healing  took  place,  are  not  very  rare.'' 
Thus  Callender  removed  a  needle  from  the  substance  of  the 
heart.  But  there  is  perhaps  onl}'  one  case '  on  record  in  which 
a  wound  penetrating  the  cavities  of  the  heart  was  recovered 
from.  It  is  the  rule  rather  than  the  exception  that  wounds  of 
the  heart,  penetrating  or  not,  are  not  immediately  fatal.  Thus 
in  a  series  of  twenty-nine  cases  of  penetrating  wounds  men- 
tioned by  Devergie,'  as  collected  b}"  Ollivier  and  Sanson,  only 
two  ended  fatally  within  forty-eight  hours,  the  rest  in  periods 
ranging  from  four  to  twenty-eight  days.  This  delay  in  the 
fatal  result  has  been  attributed  to  the  arrangement  of  the  muscle 
fibres  crossing  one  another  and  tending  to  close  the  wound,  or 
at  least  to  make  it  smaller.  As  to  the  various  parts  of  the 
heart  wounded,  the  right  side,  especially  the  ventricle,  is  most 
often  wounded.  Thus  out  of  fifty-four  cases  of  wounds  of  the 
heart,  Taylor '  states  that  the  right  ventricle  was  wounded  in 
twenty-nine  cases,  both  ventricles  in  nine,  the  right  auricle  in 
three,  and  the  left  auricle  in  one  case.  This  greater  frequency 
of  wounds  of  the  right  side  of  the  heart  is  easily  accounted  for 
by  its  more  exposed  position  anteriorly,  just  beneath  the  chest 
wall  in  a  part  of  its  extent.  The  rapidity  of  death  depends 
largely  upon  the  site  and  extent  of  the  wound.  Lutaud  ^  states 
that  out  of  twenty-four  cases  of  wounds  of  the  right  ventricle 
only  two  were  fatal  within  forty-eight  hours,  and  out  of  twelve 
cases  of  wounds  of  the  left  ventricle  three  were  not  immediately 
fatal.  Wounds  of  the  auricles  are  generall}"  fatal  immediately, 
especially  if  the  cavitj"  is  extensively  laid  open.  It  is  the 
general  opinion  that  wounds  of  the  auricles  are  most  rapidly 

iBeck,    vol.     ii.,    pp.    329,    333;  1861,  p.  292.     Case  of  bullet  in  heart 

Wharton  and  Stille,  2d  Ed.,  p.  580;  wall  for  twenty  years. 

N.    A.    Med.    and    Chir.     Review,  ^Edin.    Med.   and    Surg.     Jour., 

March,   1859,    p.   299;    N.   Y.   Med.  Oct.,  1844,  p.  557. 

Times,  Apr.  and  May,  1855;  Amer.  -"'Med.  Leg.,"  t.  2,  p.  253. 

Jour.  Med.    Sciences,  Julv,  1861,  p.  '^•'Med.       Jurisprudence,"      11th 

292,  and  Aug.,  1829.  p.  307.  Amer.  Ed.,  1892. 

-Amer.    Jour.    Med.  Sci.,   Julv,  •*" Manuel  Med.   Leg.,"  5th  Ed., 

1892. 


WOUNDS    OP   THE    HEART.  577 

fatal,  next  those  of  the  right  ventricle,  and  lastly  those  of  the 
left  ventricle.  This  difference  is  probably  due  to  the  compara- 
tive thickness  of  the  walls  of  these  parts.  Thus  the  wall  of  the 
left  ventricle  is  so  thick  as  to  tend  to  close  a  wound  unless  it  be 
extensive.  In  wounds  of  the  heart  death  rarely  occurs  from 
external  hemorrhage,  which  ma}^  be  quite  slight  or  even  alto- 
gether wanting  where  the  wound  is  due  to  a  crush  or  fracture 
of  the  ribs.  Death  is  usually  due  to  the  compression  of  the 
heart  by  the  blood  in  the  pericardium.  This  usuall}'-  causes 
syncope,  or  a  slighter  pressure  may  be  fatal  by  causing  cerebral 
or  pulmonary  anaemia  or  shock.  Death  may  occur  suddenly 
in  this  manner  or  not  until  after  some  time.  Thus  in  penetrat- 
ing stab- wounds  little  or  no  blood  probably  escapes  at  first,  in 
most  cases,  but  it  ma}-  ooze  or,  later  on,  suddenly  burst  out  into 
the  pericardium.  Therefore  after  a  wound  of  the  heart  the 
patient  does  not,  as  a  rule,  die  immediately,  as  formerly  and 
often  at  the  present  time  erroneously  supposed.  This  fact  is 
of  little  importance  as  a  rule  in  surgery,  for  the  patients  gener- 
ally die  sooner  or  later,  but  it  is  of  importance  in  medical 
jurisprudence,  for  upon  it  may  hang  the  solution  of  questions  of 
murder,  suicide,  or  justifiable  homicide.  It  also  accounts  for 
the  fact  that  the  injured  person  can  exercise  voluntary  power 
after  the  injur}'.  Thus  Watson '  met  with  a  case  where  a  man 
ran  eighteen  yards  and  died  six  hours  after  a  stab-wound  of 
the  right  ventricle.  The  coronary  artery  was  divided  and  the 
pericardium  was  filled  with  blood.  Also  Boileau  met  with  an 
accidental  penetrating  stab-wound  through  both  ventricles  in  a 
soldier  who  ran  two  hundred  yards,  then  fell  and  died  in  five 
minutes.  A  boy  admitted  to  Guy's  Hospital  in  1879  lived 
forty-two  hours  with  a  bayonet-wound  transfixing  the  right 
auricle,  the  septum,  the  left  ventricle,  the  mitral  valve,  and 
entering  the  left  auricle. 

Minute  wounds  of  the  chest  are  sometimes  made  by  needles, 
etc.,  in  the  region  of  the  heart  with  the  intention  of  killing 
infants  or  children.  Taylor"  also  mentions  the  case  of  a  fatal 
wound  of  the  heart  from  a  needle,  the  result  of  accident.  We 
have  already  cited  the  case  of  a  needle  lodged  in  the  heart  wall 

'  Quoted  by  Taylor,  "Med.  Juris-  '-"Med.       Jurisprudence,"      11th 

prudence,"  11th  Amer.  Ed.,  1892,  p.        Amer.  Ed.,  1892,  p.  351. 
340. 

37 


578  WOUNDS — WOOLSEY. 

and  removed  by  Callender  by  operation.  That  the  puncture  of 
the  heart  by  a  small  instrument  is  not  necessarily  serious  is 
proved  by  the  experiments  of  Senn,'  by  which  he  found  that 
"the  heart  can  be  punctured  with  a  perfectly  aseptic,  medium- 
Sized  aspirator  needle  without  any  great  immediate  or  remote 
danger." 

In  cases  of  rupture  of  the  heart  the  question  may 
come  up  as  to  whether  it  was  the  result  of  disease  or  violence. 
We  have  already  seen  that  rupture  of  the  heart  may  occur  from 
falls  or  crushes  without  marks  of  violence  to  the  chest.  In 
general,  we  may  say  that  in  rupture  of  the  heart  from  violence 
the  right  side  and  base  are  most  often  involved,  while  in  rup- 
ture from  disease  the  left  ventricle  is  generally  ruptured, 
especially  near  the  apex.  The  exciting  causes  of  rupture  of  a 
diseased  heart  are  often  violent  emotions  or  exertion,  which 
majT"  both  be  present  in  a  quarrel  with  another  and  cause  rup- 
ture without  direct  violence.  The  cause  need  be  but  slight  if 
the  heart  is  diseased,  whether  the  cause  is  a  natural  one  or  out- 
ward violence.  Rupture  from  disease  may  therefore  excite 
suspicions  of  murder,  but  those  cases  can  usually  be  satisfac- 
torily solved  by  examination  of  the  organ  post  mortem.  A 
slight  degree  of  violence  may  cause  rupture  of  a  diseased  heart 
about  ready  for  rupture  from  natural  causes.  When  a  diseased 
heart  ruptures  during  a  quarrel,  the  symptoms  of  rupture  of  the 
heart  may  be  observed  to  come  on  suddenly  before  and  without 
the  infliction  of  any  violence. 

Wounds  of  Arteries  and  Veins,  especially  within  the 
thorax. — Wounds  of  large  trunks  are  generally  speedily  mortal. 
In  the  chest  we  may  occasionally  meet  with  wounds  of  the  in- 
tercostal or  internal  mammary  vessels  or  the  vena  azygos  veins. 
These  wounds  are  often  serious  and  ma}'  be  fatal.  We  have 
a,lready  seen  that  blood  in  the  large  cavities  of  the  bod}",  like 
the  chest,  is  commonly  not  coagulated,  or  at  least  the  greater 
part  of  it.  We  have  already  seen,  too,  that  after  wounds  of  the 
carotid  artery  the  victim  may  preserve  the  power  of  locomotion 
for  a  short  time,  but  not  the  power  of  struggling.  This  fact 
may  be  important  to  help  distinguish  between  murder  and 
suicide.  In  such  wounds  of  the  carotid  the  voice  may  be  lost, 
as  the  trachea  is  often  divided.  Death  from  wounds  of  large 
'Senn,  "Experimental  Surgery."  1889. 


WOUNDS  OF  THE  ARTERIES,  VEINS,  AND  DIAPHRAGM.      579 

vessels  ma}"  be  due  to  loss  of  blood,  and  if  this  danger  is  passed 
the  case  may  still  terminate  fatally,  as  in  a  case  where  the 
brachial  was  tied  for  injury  and  death  occurred  in  three  days 
from  gangrene.  The  wounds  of  comparatively  small  vessels 
may  prove  fatal  from  hemorrhage,  etc. 

In  wounds  of  blood-vessels  death  may  occur  from  the  en- 
trance of  air  into  them.  In  some  cases  where  this  is  supposed 
to  have  occurred  it  is  quite  probable  that  death  was  really  due 
to  hemorrhage.  A  considerable  quantity  of  air  may  enter  the 
circulation,  especially  the  arterial  circulation,  without  a  fatal 
result.  When  death  does  occur  it  is  owing  (1)  to  "mechanical 
over-distention  of  the  right  ventricle  of  the  heart  and  paralysis 
in  the  diastole,"  or  (2)  to  "asphyxia  from  obstruction  to  the 
pulmonary  circulation  consequent  upon  embolism  of  the  pul- 
monary artery."  Senn  found  that  fatal  air  embolism  could 
hardly  occur  spontaneously  in  a  healthy  jugular  vein,  as  the 
walls  collapse  readily  from  atmospheric  pressure. 

Wounds  and  Ruptures  of  the  Diaphragm. — These 
may  be  due  to  weapons,  fracture  of  the  ribs,  falls  or  crushes, 
and  disease.  They  also  occur  as  the  result  of  congenital  mal- 
formation, though  these  cases  seldom  survive  long.  These 
injuries  are  generally  homicidal  or  accidental  in  origin.  As 
a  rule,  the  viscera  are  wounded  at  the  same  time,  or,  if  not 
Avounded,  at  least  herniated,  and  may  thus  become  strangulated. 
It  is  therefore  hard  to  estimate  the  danger  in  such  cases,  but 
the  prognosis  is  at  all  times  serious.  The  most  serious  cases 
of  such  injury  to  the  diaphragm  are  due  to  violent  contusions 
or  falls  when  the  stomach  and  intestines  are  full.  The  hemor- 
rhage is  usually  slight,  but  hernia  of  one  or  more  of  the  ab- 
dominal viscera  usually  occurs  in  such  cases,  and  is  said  to  be 
more  readily  produced  during  inspiration  when  the  fibres  are  on 
the  stretch.  According  to  Devergie,  rupture  of  the  diaphragm 
with  hernia  is  more  common  on  the  left  side  in  the  central 
tendon  in  front  of  the  crura  and  at  the  junction  of  the  left  mus- 
cular leaflet.  Also  on  either  side  of  the  ensiform  cartilage  and 
especially  on  the  left  side  there  occurs  an  area  of  the  diaphragm 
which  may  be  congenitally  weak  or  even  absent,  and  here  too 
rupture  and  hernia  are  likely  to  occur.  Phrenic  or  diaplirag- 
niatic  hernia  occurs  especially  after  lacerated  wounds,  even 
'  Senn,  "Experimental  Surgery,"  1889. 


580  WOUNDS — WOOLSEY. 

after  the  wounds  have  apparently  healed.  If  hernia  occurs 
long  after  the  injury  was  inflicted,  it  may  be  asked  whether 
the  wound  was  the  cause  of  the  hernia,  and  so  of  death.  This 
can  only  be  determined  by  examination.  Almost  any  or  all  of 
the  movable  abdominal  viscera  may  be  found  in  a  diaphrag- 
matic hernia.  It  was  once  supposed  that  this  accident  would 
be  immediately  fatal,  but  this  is  far  from  the  truth.  Devergie 
relates  the  case  where  a  person  lived  nine  months  with  the 
stomach  and  colon  in  the  chest  and  died  from  another  cause. 
Thus  a  person  may  have  a  phrenic  hernia  and  die  from  another 
cause,  or  having  had  a  rupture  or  wound  of  the  diaphragm  he 
may  suddenly  acquire  a  diaphragmatic  hernia  by  reason  of  a 
blow  or  sudden  exertion,  or  the  latter  may  strangulate  an  exist- 
ing hernia.  A  person  with  a  diaphragmatic  hernia  may  have 
the  power  of  moving  or  walking,  but  is  more  or  less  incapaci- 
tated owing  to  the  compression  of  the  lungs  which  exists  and 
the  consequent  dyspnoea,  etc. 

WOUNDS  AND  CONTUSED  INJURIES  OF  THE  ABDOMINAL 
WALL  AND  VISCERA. 

Such  wounds  and  injuries  of  the  abdominal  wall  may  be  in- 
cised, punctured,  or  due  to  blunt  instruments,  etc.  They  are 
usually  homicidal  or  accidental,  seldom  suicidal  except  in 
delirious  patients  or  lunatics.  The  cause  of  death  in  such  cases 
may  be  due  to  hemorrhage,  shock,  etc.,  or  to  secondary  inflam- 
mation, which  is  especially  likely  to  occur  in  penetrating 
wounds.  The  kind  of  weapon  used  may  often  be  judged  from 
the  nature  of  the  wound.  Incised  and  non-penetrating  punc- 
tured wounds  are  usually  simple  and  not  grave,  but  may  be 
otherwise  from  hemorrhage  from  the  deep  epigastric  artery,  or 
from  inflammation  in  or  between  the  muscles,  or  in  the  sub- 
peritoneal connective  tissiie.  In  the  latter  case  peritonitis  may 
occur,  but  is  rare.  A  ventral  hernia  may,  however,  result 
later  on,  as  also  from  a  cicatrix,  especially  if  it  is  transverse. 
In  such  cases  the  question  arises  whether  the  natural  results  of 
the  wound  were  aggravated  by  unskilful  or  improper  treat- 
ment or  even  wilful  neglect  on  the  part  of  the  patient  or 
practitioner. 

Contusions  of  the  abdomen  are  more  serious  often  than 
those  of  the  chest,  for  there  is  less  power  of  resistance.     We 


WOUNDS   OF   THE   ABDOMINAL  WALL   AND    VISCERA.       581 

have  already  seen  that  death  may  occur  from  a  contusion  of 
the  abdomen  too  slight  to  show  a  mark  of  ecchymosis  or  a 
serious  injury  internally.  This  has  been  attributed  by  some  to 
an  effect  on  the  solar  plexus  or  reflexly  on  the  cardiac  plexus 
causing  a  fatal  inhibition.  Lutaud  and  others  have  expressed 
the  doubt  whether  the  cases  reported  by  Travers,  Allison, 
Watson,  Cooper,  Vibert,  and  others  were  carefully  examined, 
and  have  inferred  that  some  visible  organic  change  must  have 
been  present.  Some  such  cases,  however,  have  been  examined 
with  especial  reference  to  this  point,  and  no  physical  injuries 
and  no  other  cause  of  death  elsewhere  has  been  found.  There 
is  no  ground,  therefore,  for  a  jury  to  doubt  that  a  contusion  of 
the  abdomen  was  the  cause  of  death  because  there  are  no  visible 
marks  of  injury. 

Again,  it  is  a  well-known  fact  that  the  blows  severe  enough 
to  cause  rupture  of  the  abdominal  viscera  may  sometimes  leave 
no  trace  of  violence  in  or  on  the  abdominal  wall.  On  the  other 
hand,  it  must  be  remembered  that  effusions  of  blood  may  be 
found  post  mortem  in  the  sheaths  of  muscles  without  indicat- 
ing violence,  so  that  blood  ma}"  be  found  effused  in  considerable 
quantity  in  and  around  the  abdominal  muscles  without  violence 
having  been  done.  In  such  cases,  therefore,  we  should  note 
whether  abrasions  or  ecchymoses  of  the  skin  are  absent  or  not. 
If  they  are  absent  and  there  is  no  other  evidence  of  a  blow,  the 
medical  witness  should  hesitate  to  attribute  such  an  effusion  of 
blood  between  the  muscles  to  an  act  of  violence. 

As  in  the  case  of  the  chest,  so  wounds  of  the  abdomen  are 
serious,  as  a  rule,  mainly  as  they  involve  the  abdominal  viscera. 
The  viscera  may  be  wounded  by  a  penetrating  wound  or  by 
rupture,  and  the  fatal  result  is  due  sometimes  to  internal  hemor- 
rhage or  to  shock,  but  generally  to  secondary  septic  peritonitis, 
which  may  be  fatal  in  a  few  hours  or  onl}'  after  days  or  weeks. 
Occasional!}^  wounds  of  the  abdominal  viscera  undergo  sponta- 
neous cure  without  surgical  interference  and  with  or  without 
medical  treatment.  But  as  a  rule  they  are  fatal  unless  the}' 
receive  proper  surgical  treatment.  A  wound  of  the  abdominal 
wall  may  be  penetrating  without  wounding  any  of  the  viscera. 
Such  wounds  may  be  fatal  if  they  are  infected,  otherwise  they 
usually  heal  readily  and  witliout  danger  unless  they  are  exten- 
sive and  the  abdominal  contents  are  exposed  to  the  air.     The 


582  WOUNDS — WOOLSEY. 

gravity  of  penetrating  wounds  varies  somewhat  with  the  par- 
ticular viscus  or  viscera  injured.  It  is  well  not  to  examine 
wounds  of  the  abdomen  by  the  finger  or  probe  too  freely  unless 
a  laparotomy  is  anticipated;  for  a  simple  wound  or  penetrat- 
ing wound  without  wounding  of  the  viscera  may  thus  be  in- 
fected. Enough  examination  is  necessary  to  diagnose  between 
a  simple  and  a  penetrating  wound  of  the  abdominal  wall. 

RUPTURE  OR  WOUNDS  OF  THE  ABDOMINAL  VISCERA. 

The  Liver  is  most  often  wounded  of  any  of  the  abdominal 
viscera,  with  the  possible  exception  of  the  intestines,  because  of 
its  size,  and  it  is  most  often  ruptured  partly  because  of  its  size, 
but  mostly  owing  to  its  friable  consistence.  Such  injuries 
most  often  involve  the  right  lobe,  as  it  is  much  the  larger  of  the 
two  principal  lobes.  The  anterior  surface  and  inferior  border 
is  the  most  frequent  site  both  of  wounds  and  ruptures  of  the 
organ.  Ruptures  rarely  pass  entirely  through  the  organ,  but 
are  generally  not  more  than  an  inch  or  two  in  depth.  They 
are  usually  directed  antero-posteriorly  or  obliquely,  rarel}^  trans- 
versely, and  the  lacerated  granular  edges  are  not  much  separated 
as  a  rule  (see  Fig.  21).  Rupture  of  the  liver  may  be  due  to  a 
blow,  crush,  or  fall,  or  even  to  sudden  muscular  action  if  the  organ 
is  large  and  fatt}^.  Thus  Taylor '  relates  the  case  of  a  woman 
who  died  after  child-birth  of  ursemic  convulsions,  and  in  whom 
there  was  quite  an  extensive  hemorrhage  into  the  liver  beneath 
its  capsule,  and  apparently  due  to  violent  muscular  contraction. 
As  we  have  already  seen,  the  liver  may  be  ruptured  without 
the  abdomen  showing  the  marks  of  external  violence.  Rup- 
ture or  wound  of  the  liver  is  one  of  the  causes  of  the  fatality  of 
wounds  and  injuries  of  the  abdomen.  The  fatal  result  ma}'  be 
and  often  is  due  to  hemorrhage;  in  other  cases  it  is  due  to 
shock  or  the  occurrence  of  peritonitis.  Wounds  of  the  liver 
heal  readily  and  hemorrhage  is  arrested  at  once,  as  a  rule,  by 
the  approximation  of  the  edges.  There  may  be  little  blood  in 
and  about  the  wound,  but  it  collects  in  the  right  iliac  region  or 
in  the  pelvis  and  is  not  wholly  coagulated.  Unless  the  wound 
or  rupture  involves  the  vena  cava,  portal  vein,  or  a  large  branch 
of  either  of  these,  the  hemorrhage  is  apt  to  be  slow  and  the 
'"Med.  Jurisprudence,"  11th  Amer.   Ed.,  1892. 


RUPTURE  OR  WOUNDS  OF  THE  ABDOMINAL  VISCERA.      583 

victim  may  survive  hours  or  even  clays,  except  for  active  exer- 
tion or  repeated  violence.  Two  cases  illustrating  the  slowness 
of  the  hemorrhage  have  occurred  in  Guy's  Hospital.  In  one  ' 
the  man,  showing  no  urgent  sj-mptoms  at  the  time,  was  sent 
away,  and  died  a  few  hours  later  in  a  police-station.     In  this 


Fig.  21.— Ruptures  of  the  Liver  from  a  Fall  from  a  Considerable  Height,  causing  Imme- 

diat«  Death. 

case  the  liver  was  ruptured  nearly  through  its  thickness,  and  a 
basinful  of  blood  had  been  effused,  causing  death.  In  the  other 
case,''  which  occurred  to  Wilks,  the  patient  survived  the  acci- 
dent ten  days,  and  Taylor '  cites  a  case  which  was  reported  to 

'Med.   Times  and  Gazette,   1864,  '"'Med.      Jurisprudence,"      11th 

ii.,  527.  Amer.  Ed.,  1892,  p.  347. 

'  Med.  -Chir.  Rev. ,  1836,  p.  296. 


584  WOUNDS — WOOLSEY. 

have  ended  fatally  eight  years  after  the  accident.  As  a  rule 
the  injury  is  fatal,  without  treatment,  within  forty-eight  hours. 
Not  being  immediately  fatal  as  a  rule,  the  victim  of  a  rupture 
or  wound  of  the  liver  can  walk  about,  and  may  be  capable  of 
more  or  less  severe  muscular  exertion  after  the  injur}',  though 
the  fact  of  such  exertion  has  sometimes  been  used  by  the  defence 
to  prove  that  the  rupture  was  not  due  to  the  particular  violence 
in  question. 

Wounds  and  ruptures  of  the  gall-bladder  result  in  the 
effusion  of  bile.  While  rupture  of  the  liver  is  not  necessarily 
followed  by  peritonitis,  rupture  of  the  gall-bladder  with  the 
effusion  of  bile  generally  causes  peritonitis,  and  is  fatal  in  this 
way  and  not  from  hemorrhage.  Rupture  of  the  gall-bladder 
may  be  favored  by  the  presence  of  gall-stones,  but  the  result  is 
still  attributable  to  the  injury. 

Spleen. — Ruptures  of  the  spleen  may  be  due  to  a  bruising 
violence  in  this  region,  and  here  too  the  skin  may  not  show  the 
marks  of  the  contusion,  though  this  fact  is  still  employed  b}'  the 
defence  to  try  to  disprove  the  connection  between  the  injury 
and  the  result.  It  is  important  to  remember,  from  a  medico- 
legal point  of  view,  that  an  enlarged  and  softened  spleen  may 
be  ruptured  from  a  comparatively  slight  muscular  exertion. 
This  might  occur  in  a  sudden  movement  to  avoid  a  blow,  and 
the  charge  of  manslaughter  might  be  affected  by  the  mode  of 
the  production  of  the  injury  and  the  previous  abnormal  condi- 
tion. Only  direct  violence  is  liable  to  rupture  the  healthy  nor- 
mal spleen.  Rupture  and  wounds  of  the  spleen  may  be  and 
generally  are  fatal  from  hemorrhage,  owing  to  the  vascularity 
of  the  organ ;  more  rarely  are  they  fatal  from  shock.  Peritoni- 
tis is  not  a  result  to  be  expected. 

The  hemorrhage  accumulates  in  the  lower  and  left  side  of 
the  abdomen  or  in  the  pelvis,  and  coagulation  is  imperfect  if 
present  at  all. 

Kidneys. — These  are  occasionally  ruptured  from  violence, 
but  more  often  from  accident.  Wounds  of  the  kidney  are  rare, 
owing  to  the  depth  from  the  surface  at  which  they  lie.  They 
are  more  accessible  from  behind.  A  wound  from  behind  is 
generally  extra-peritoneal  unless  it  perforates  the  organ;  not 
so  a  wound  from  in  front.  Accidents  in  which  the  lumbar 
region  is  forcedly  flexed  are  most  apt  to  be  followed  by  injury 


SPLEEN — KIDNEYS — BLADDER.  585 

to  the  kidney.  The  injury  may  cause  no  prominent  symptoms, 
but  usually  lumbar  pain  and  tenderness,  frequent  micturition 
and  hematuria,  and  in  severe  cases  the  symptoms  of  hemor- 
rhage and  shock  are  present.  The  injury  may  be  speedily  fatal 
from  hemorrhage  or  collapse,  or  more  slowlj'-  fatal  from  peri- 
tonitis, when  the  peritoneum  is  involved,  or  from  abscess  and 
septic  infection,  or  from  uraemia  if  the  other  kidney  is  diseased. 
Slight  injuries  are  generally  recovered  from.  As  is  the  case 
with  the  liver  and  spleen,  so  after  injuries  of  the  kidney  the 
victim  may  walk  about,  etc. ,  unless  there  is  copious  and  imme- 
diate hemorrhage. 

The  bladder  may  be  wounded  directly  through  the  hypo- 
gastrium,  vagina,  or  rectum  ;  it  may  be  punctured  by  a  broken 
fragment  of  the  pelvis,  especially  the  pubis,  or  it  may  frequently 
be  ruptured  from  blows,  crushes,  or  falls.  The  latter  accident 
occurs  especially  where  the  bladder  is  distended.  The  bladder 
may  also  rupture  spontaneously  from  over-distention,  which 
may  or  may  not  be  favored  by  disease  of  the  bladder  wall,  in 
which  case  rupture  occurs  more  easily,  Medico-legally  the 
question  may  arise  whether  the  rupture  was  spontaneous  or  due 
to  injury.  In  this  connection  it  should  be  remembered  that  the 
injury  may  leave  no  external  mark  of  violence,  and  a  case  is 
recorded  in  which  the  bladder  was  ruptured  by  a  fall  in  wres- 
tling ;  but  the  question  can  be  determined  only  by  an  examination 
of  the  bladder.  If  the  wall  of  the  bladder  is  thinned  by  the  pres- 
sure of  a  calculus  or  from  other  causes,  or  if  it  is  weakened  by 
tubercular,  syphilitic,  or  carcinomatous  deposits  or  ulcerations, 
it  may  be  spontaneously  ruptured  from  slight  distention  or  a 
slight  degree  of  violence  may  rupture  it.  If  violence  has  been 
employed  it  is  responsible  for  the  rupture,  though  the  diseased 
condition  may  act  as  a  mitigating  circumstance ;  not  so  a  dis- 
tended bladder,  as  the  latter  is  not  abnormal.  In  spontaneous 
rupture  from  over-distention  without  disease  of  the  bladder 
wall,  stricture,  hypertrophied  prostate,  or  some  such  condition 
must  be  present  to  account  for  the  over-distention.  Spontane- 
ous rupture  of  the  bladder  can,  therefore,  only  occur  when 
either  disease  of  the  bladder  wall  or  obstruction  of  the  urethra 
is  present.  No  condition  excludes  rupture  from  violence.  If 
there  is  an  injury  followed  by  the  symptoms  of  rupture  of  the 
bladder  and  death  and  the  bladder  and  urethra  are  healthy, 


58G  WOUNDS — WOOLSEY. 

there  can  be  little  doubt  that  death  was  due  to  the  injury. 
Wounds  or  rupture  of  the  bladder  may  be  extra-peritoneal  or 
intra-peritoneal.  Rupture  from  disease  of  the  bladder  wall 
occurs  at  the  site  of  the  diseased  and  weakened  spot,  which  is 
most  often  at  the  base  of  the  bladder.  Rupture  of  the  bladder 
from  violence  occurs  most  often  on  the  postero-superior  wall, 
running  downward  from  the  urachus,  in  which  case  the  peri- 
toneum would  be  involved.  A  punctured  wound  of  the  bladder 
wall  may  be  so  minute  that  the  leakage  is  very  slow  and  the 
customary  symptoms  may  be  obscured,  or  the  opening  may  be 
valvular  in  character,  perhaps  allowing  escape  of  urine  only 
when  the  bladder  is  not  distended.  The  symptoms  consist  of 
pain,  inability  to  micturate,  and  the  presence  of  blood  in  the 
little  fluid  which  can  be  drawn  by  a  catheter.  Fluid  injected 
is  not  all  returned  and  the  bladder  cannot  be  distended.  After 
a  time  varying  from  a  few  hours  to  a  few  days,  depending  upon 
the  size  of  the  opening  and  the  condition  of  the  urine,  peritoni- 
tis or  peri-vesical  cellulitis  is  set  up,  the  former  being  generally 
fatal,  the  latter  not  necessarily  so.  Prompt  surgical  treatment 
may  save  the  patient's  life  by  avoiding  peritonitis.  Extra- 
peritoneal ruptures  are  far  less  dangerous  than  intra-peritoneal, 
as  in  the  former  case  cellulitis  and  abscess  in  the  cellular  tissue 
around  the  bladder,  which  may  subsequently  be  treated  by  oper- 
ation and  drainage,  take  the  place  of  peritonitis  in  the  latter 
case,  for  which  prevention  is  the  only  safe  treatment.  In  extra- 
peritoneal rupture  death,  if  it  occurs,  is  generally  due  to  septi- 
caemia ;  in  the  intra-peritoneal  variety  it  is  due  to  peritonitis. 
These  cases  of  injury  to  the  bladder  may  die  suddenly  and 
speedily  from  shock  or  from  peritonitis  in  three  to  seven  days, 
or  not  until  fifteen  days  or  so.  In  punctured  and  incised 
wounds  the  urine  escapes  more  slowly,  peritonitis  develops  less 
early,  and  death  is  longer  delayed.  Hemorrhage  in  injury  to 
the  bladder  is  not  visually  serious;  the  blood  is  found  partly  in 
the  bladder,  partly  in  the  pelvis,  where  the  fluid  extravasated 
by  peritonitis  is  also  found.  The  victim  of  a  wound  or  rupture 
of  the  bladder  may  often  walk  about  for  some  time  after  the 
injury. 

Stomach  and  Intestines.— Punctured  wounds,  or,  more 
rarely,  incised  wounds  of  the  abdomen  may  involve  these 
organs,  or  they  may  be  ruptured  by  blows,  crushes,  and  falls,  or 


STOMACH   AND    INTESTINES.  587 

from  disease.  Stab-wounds  of  these  viscera  may  be  multi- 
ple from  a  single  stab,  the  instrument  traversing  one  coil, 
perhaps,  and  then  wounding  others,  though  this  is  less  often 
the  case  than  with  gunshot  wounds.  Ruptures  too  may  be 
multiple,  though  less  often  so  than  wounds.  The  ileum  is  most 
liable  to  rupture,  though  several  cases  of  rupture  of  the  jeju- 
num are  on  record.  Like  the  bladder,  the  stomach  and,  to  a  less 
extent,  the  intestines  are  more  liable  to  be  ruptured  when  dis- 
tended. Ruptures  of  the  stomach  or  intestines  are  seldom 
attended  with  much  hemorrhage,  while  wounds  may  occasion- 
ally cause  a  serious  and  fatal  hemorrhage  from  the  wounding 
of  a  large  blood-vessel.  The  principal  danger  lies  in  the  leakage 
of  the  contents  of  the  stomach  and  intestines,  which  almost 
always  sets  up  a  septic  peritonitis.  This  may  sometimes  be- 
come localized  and  go  on  to  spontaneous  cure,  though  as  a  rule 
it  becomes  general  and  is  fatal.  In  such  cases  early  operation 
may  avoid  the  fatal  peritonitis.  A  punctured  wound  may  be 
so  small  as  to  be  closed  by  the  mucous  membrane,  avoiding  the 
escape  of  the  contents  of  the  gut.  Or  a  wound  may  not  entirely 
penetrate  the  wall  of  the  stomach  or  intestines,  which  only 
gives  way  some  days,  perhaps,  after  the  injury,  though  the  in- 
jury is  entirely  responsible  for  the  delayed  result.  These  in- 
juries are  sometimes  fatal  immediately  or  very  speedily  from 
shock,  while  in  other  cases  of  very  extensive  injury  there  may 
be  almost  no  shock,  and  the  victim  is  aware  of  no  serious 
injury.  It  is  an  important  point  to  remember  medico-legally 
that  spontaneous  rupture  of  the  stomach  or  intestines  may  occur 
owing  to  ulceration  due  to  disease.  This  can  be  determined  by 
a  careful  examination  of  the  wall  of  the  stomach  or  intestines  at 
the  site  of  the  rupture.  A  slight  injury  may  also  cause  rupture 
if  the  wall  of  the  gut  is  weakened  by  disease,  as  the  disease 
causes  greater  liability  to  rupture.  Here  too  it  is  to  be  remem- 
bered that  a  severe  injury  causing  rupture  may  leave  no  mark 
of  violence  on  the  abdominal  wall.  The  power  of  walking  or 
other  muscular  exertion  after  such  injuries  of  the  stomach  or 
intestines  is  not  infrequently  preserved,  as  recorded  in  numer- 
ous cases.'  The  prognosis  in  such  injuries  of  the  stomach  and 
intestines  is  always  extremely  grave. 

'Lancet,  1873,  ii.,  p.  10. 


588  WOUNDS — WOOLSEY. 


Incised,  Punctured,  and  Contused  Wounds  of  the 
Genital   Organs. 

These  are  not  common  as  medico-legal  cases.  Self -castra- 
tion or  mutilation  is  sometimes  practised  by  lunatics,  idiots, 
or  even  intoxicated  persons.  Thus  a  man  who,  while  intox- 
icated, cut  off  his  genital  organs  and  died  the  next  day  from 
the  effects  of  hemorrhage  was  seen  by  Demarquay.'  Circum- 
cision in  infants  is  also  sometimes  fatal  from  phlegmonous  in- 
flammation. ° 

Incised,  lacerated,  or  contused  wounds  of  the  female  genitals 
may  be  fatal  from  hemorrhage  from  many  small  vessels. 
Deeply  incised  wounds  of  the  female  genitals  proves  wilful  and 
deliberate  malice ;  accident  is  out  of  the  question  and  suicide 
is  improbable  in  such  cases.  But  we  sometimes  have  to  deter- 
mine between  accidental,  self-inflicted,  and  homicidal  wounds 
of  these  parts,  as  accidental  wounds  may  occasionally  resemble 
those  made  by  design  and  so  may  furnish  more  or  less  difficulty, 
unless  all  the  circumstances  are  known.  Thus  Tajdor '  relates 
the  case  of  a  child  in  whom  a  sharp-pointed  stick  entered  and 
passed  through  the  posterior  wall  of  the  vagina  as  she  fell  from 
a  tree.  The  stick  was  removed  by  a  woman,  and  the  child  died 
in  a  little  over  a  day  from  peritonitis.  Unless  the  circum- 
stances were  known,  this  case  might  have  caused  suspicion  of 
homicide. 

Lunatics,  idiots,  and  drunkards  sometimes  inflict  on  them- 
selves wounds  unlike  ordinary  suicidal  ones.*  In  other  cases  the 
various  points  we  have  enumerated  in  a  previous  section  to 
distinguish  between  suicide,  homicide,  and  accident  may  be 
applied  to  solve  the  case. 

Contused  wounds,  such  as  kicks,  etc.,  of  the  female  genitals 
may  be  fatal  from  hemorrhage  due  to  the  laceration  of  the  parts.  ^ 
Like  the  wounds  of  the  eyebrows,  contused  wounds  of  the  vulva 
may  sometimes  resemble  incised  wounds  owing  to  the  sharp 
bony  surfaces  beneath.  Careful  examination  allows  a  discrimi- 
nation to  be  made  from  incised  wounds.     If  hemorrhage  occurs 

^Lancet,  1870,  ii.,  p.  471.  ^"Med.  Jurisprud.,"  11th  Amer. 

-See     Taylor,     "Med.     Jurispru-  Ed.,  1892. 

deuce,"    11th  Amer.    Ed.,   1892,  p.  ■» See  Taylor,  "Med.  Jurisprud.," 

348.  11th  Amer.  Ed.,  1892,  p.  351. 


WOUNDS  OF  THE  GENITAL  ORGANS  AND  EXTREMITIES.     589 

a  long  time  after  the  alleged  violence,  it  is  probably  due  to 
natural  causes,  especially  in  cases  of  metrorrhagia,  etc.  It  may 
be  alleged  in  defence  that  contused  wounds  of  the  female  geni- 
tals were  inflicted  post  mortem,  but  besides  the  other  features 
which  we  have  already  seen  help  to  distinguish  between  ante- 
mortem  and  post-mortem  wounds,  we  may  add  that  kicks  and 
other  contusions  of  the  vulva,  if  fatal,  are  so  from  hemorrhage 
or  effusion  of  blood,  and  no  post-mortem  hemorrhage  is  enough 
to  cause  death. 


INCISED,  PUNCTURED,  AND  CONTUSED  WOUNDS  OF  THE 
EXTREMITIES. 

These  may  be  fatal  if  a  large  blood  vessel  or  vessels  are 
opened,  or  sometimes  if  a  compound  fracture  or  wound  of  a 
joint  becomes  infected.  They  ma}^  also  in  some  cases  be 
fatal  from  shock,  from  the  severity  of  the  injur}''.  As  a  rule 
they  are  the  cause  of  civil  suits,  not  of  criminal  ones.  The 
various  injuries  may  cause  disability  for  a  longer  or  shorter 
time,  or  even  permanently,  and  more  or  less  deformity  may  also 
remain.  This  may  be  the  case  with  fractures,  especially  if  they 
occur  near  the  joints,  in  which  case  great  caution  should  be 
exercised  in  giving  an  opinion  or  prognosis.  It  is  a  common 
mistaken  idea  of  the  laity  that  a  fractured  or  dislocated  limb 
can  be  made  in  every  case  as  good  as  before  the  injury.  On 
the  contrary,  they  not  infrequently  leave  a  slight  deformity  and 
impairment  of  function,  sometimes  even  under  the  best  treat- 
ment. Dislocations  may  also  leave  a  lasting  disability  or 
weakness,  often  owing  to  the  carelessness  of  the  injured  person. 

Wounds  of  an  arter}'-  or  vein,  or  both,  may  result  in  an 
aneurism  or  an  arterio- venous  aneurism.  Wounds  of  nerves 
may  cause  paralysis  and  anaesthesia  of  the  parts  supplied. 
Wounds  of  muscles  or  tendons  may  cause  weakness  or  com- 
plete loss  of  motion  of  particular  joints.  Wounds  of  the  soft 
parts,  if  infected,  may  lead  to  cellulitis  and  phlegmonous  in- 
flammation, which  may  result  in  much  injur}-.  Wounds  of 
joints,  if  penetrating,  are  serious,  for  without  the  proper  treat- 
ment they  may  result  in  suppuration  in  the  joint,  disorganiza- 
tion of  the  joint,  and  final  ankylosis.  Before  the  use  of  antiseptic 
treatment  such  wounds  were  not  uncommonly  fatal.     Fractures, 


500  WOUNDS — WOOLSEY. 

simple  or  compound,  or  contusions  of  bone  especially  in  young 
subjects,  may  be  followed  by  osteo-periostitis  and  its  conse- 
quences, which  may  require  a  long  time  for  recovery  after  the 
fracture  is  entirely  recovered  from,  and  a  still  longer  time  be- 
fore the  limb  can  be  used.  These  and  many  other  of  the  vari- 
ous results  of  wounds  and  injuries  of  the  extremities,  causing 
deformity  or  disability,  or  both,  can  often  be  cured  or  improved 
by  surgical  treatment  or  operation. 


THE   MEDICO-LEGAL    COIsrSIDERATIO]^ 


OF 


GUNSHOT    WOUNDS. 


BY 

ROSWELL  PARK,  A.M.,  M.D., 

Professor  of  Surgery  in  the  University  of  Buffalo;  Attending  Surgeon  to  the  Buffalo 
General  Hospital;  Fellotoof  the  German  Congress  of  Surgeons:  of  the  Ameri- 
can Oi-thopasdic  Association;  of  the  American  Genito-Urinary 
Surgeons''  Association;   of  the  New  York  Academy 
of  Medicine,  etc. ,  etc. 


GU]:^SHOT   AYOTJE'DS. 

GENERAL   CONSIDERATIONS. 

Few  medical  men  there  are  who  have  long  engaged  in  prac- 
tice who  have  not  been  compelled  to  take  part  in  some  medico- 
legal controversy  in  cases  of  accidental  or  alleged  homicidal 
gunshot  wounds.  So  soon  as  death  occurs  the  surgeon  ceases 
to  work  as  such,  but  may  continue  to  work  as  a  medical  jurist, 
and  in  preparation  for  this  event  must  be  read}'  to  answer  any 
questions  bearing  upon  the  case  which,  though  possibly  ridicu- 
lous in  surgery,  are  or  may  be  necessary  in  law.  He  may  be 
called  upon  to  testify  as  to  the  precise  nature  of  a  wound  in- 
flicted upon  the  body  of  a  man  seen  before  or  after  death ;  as  to 
the  means  by  which  it  was  inflicted ;  whether  the  purport  was 
suicidal  or  homicidal ;  how  much  blood  was  lost ;  whether  the 
weapon  was  near  to  or  at  a  distance  from  the  body  when  fired ; 
whether  it  were  possible  that  the  deceased  could  have  fired  it 
himself ;  whether  after  the  reception  of  the  wound  the  person 
could  have  moved  or  performed  any  act — in  other  words,  whether 
death  was  instantaneous.  He  may  be  asked  also  as  to  genuine 
or  spurious  blood-stains,  whether  genuine  blood-stains  were 
human  or  from  some  other  animal;  whether  possibly  they  were 
from  the  body  of  the  deceased.  He  will  be  expected  to  tell 
from  what  direction  the  bullet  or  missile  was  fired ;  which  the 
wound  of  entrance  and  which  of  exit,  and  many  other  things 
possible  concerning  the  circumstances  under  which  death  oc- 
curred. It  is  unnecessary  to  state  that  questions  of  this  nature 
call  not  only  for  conventional  surgical  skill,  but  for  the  highest 
degree  of  shrewdness  and  general  information,  as  well  as  some- 
times for  expert  knowledge  with  regard  to  small-arms  and  their 
ballistics. 

It  has  been  well  said  that  the  first  duty  of  a  medical  jurist 
is  to  cultivate  a  habit  of  minute  observation.  When  this  is  com- 
bined with  a  knowledge  of  what  the  law  requires  and  with  the 
38 


594  GUNSHOT   WOUNDS — PARK. 

results  of  a  technical  education,  he  will  be  able  to  meet  all  or 
nearly  all  of  the  scientific  questions  which  may  be  asked  of 
him.  A  learned  judge  once  said  that  "  a  medical  man  when  he 
sees  a  dead  body  should  notice  everj^thing. "  Certainly  he 
should  make  a  minute  scrutiny  of  the  body  to  note  whether 
there  are  upon  the  dress  or  hands  of  the  deceased  marks  of 
blood,  or  whether  blood-stains  are  noted  in  different  parts  of 
the  room ;  whether  the  body  or  any  part  of  it  is  cold  or  warm ; 
whether  the  limbs  are  cold  or  rigid  or  pliant,  since  by  these 
means  the  accurate  date  of  death  may  be  more  accurately  deter- 
mined. 

EXAMINATION  AND  DESCRIPTION. 

In  determining  facts  attending  a  suspicious  case  of  gunshot 
wound,  there  should  be  noted,  if  known,  1st,  the  exact  time  of 
death,  as  well  as  of  infliction  of  the  wound;  2d,  location  and 
attitude  of  the  body ;  3d,  condition  of  clothing ;  4th,  anything 
of  importance  in  its  environment ;  5th,  external  appearance  of 
the  body,  as  well  as  state  of  countenance ;  6th,  exact  description 
of  all  marks  of  violence  and  of  blood-stains;  7th,  the  presence 
of  cadaveric  rigidity  and  the  surface  upon  which  cadaver  has 
been  lying,  as  well  as  its  age  and  condition  of  general  nourish- 
ment ;  8th,  time  when  deceased  was  last  seen  alive  or  known  to 
have  been  alive ;  9th,  time  after  death  at  which  examination  is 
made ;  10th,  all  physical  circumstances  corroborating  or  arous- 
ing suspicions  of  suicide  or  homicide;  11th,  account  of  an  ac- 
curate internal  post-mortem  examination,  in  which  direction 
of  the  bullet  or  missile  is  noted,  along  with  a  careful  description 
of  parts  disturbed  or  injured  in  its  course,  large  vessels  or  nerves 
cut  across,  efifusions  of  blood,  and  in  every  way  as  accurate  a 
description  as  possible  of  the  exact  damage  done.  To  this  also 
should  be  added  a  minute  scrutiny  of  other  parts,  in  order  to 
establish  clearl}'  that  death  was  due  to  the  alleged  injury,  or  on 
the  other  hand  that  it  may  have  resulted  from  natural  causes, 
and  that  the  injurj^  in  question  was  only  a  consecutive  and 
contributing  cause.  Especially  should  there  be  examined  those 
organs  in  which  occur  the  most  common  causes  of  death, 
namely,  the  brain,  the  heart  and  great  blood-vessels,  and  the 
viscera.  Moreover,  if  an  operation  has  been  performed  the 
post-mortem  examiner  should  be  prepared  to  speak  with  reason- 


EXAMINATION   AND    DESCRIPTION.  595 

able  positiveness  as  to  whether  said  operation  was,  in  the  first 
place,  necessary  if  life  were  to  be  preserved,  and,  in  the  second 
place,  whether  death  were  due  to  the  injury  proper  or  to  the 
attempt  to  save  life  thus  made  necessarj^.  For  the  determina- 
tion of  all  this,  obviously  the  best  time  for  the  performance  of 
the  examination  is  the  earliest  possible  moment  after  death. 
ISTevertheless,  bodies  are  sometimes  exhumed  for  this  purpose, 
and  much  information  is  obtainable  even  after  a  considerable 
interval  of  time. 

If  death  has  been  caused  by  a  bullet  which  has  not  passed 
through  the  body,  but  lodged,  it  should  by  all  means  be  obtained, 
since  evidence  of  the  greatest  value  ma}^  inhere  in  it.  More- 
over, in  first  noting  the  position  of  the  body,  the  direction  of 
the  wound,  or  the  location  of  a  blood-clot  upon  the  floor  or 
clothing  or  elsewhere,  may  indicate  to  the  surgeon  or  other 
astute  person  the  point  at  which  the  bullet  may  be  found  con- 
cealed or  buried  in  some  soft  or  hard  object.  This  bullet  should 
be  recovered,  if  possible,  at  all  events,  although  if  taken  from 
the  body  itself  the  evidence  it  conveys  may  possibly  weigh  more 
heavily  than  if  removed  from  some  object  outside  the  body. 
The  exact  number  of  gunshot  wounds  with  a  minute  description 
and  location  of  each  should  be  committed  to  paper  at  once,  as 
well  as  any  statement,  if  at  all  reliable,  concerning  the  number 
of  shots  fired,  since  valuable  deductions  may  be  reached  as  to 
the  number  of  bullets  which  have  passed  through  or  which  have 
lodged  within  the  body.  It  is  well  sometimes,  also,  before  dis- 
secting out  the  bullet- wound,  to  insert  first  a  stiff  and  then  a 
flexible  probe  or  something  which  shall,  if  possible,  follow  the 
bullet-track,  since  occasionallj"  a  question  comes  up  of  the  direc- 
tion in  which  it  was  fired.  Even  though  surgeons  weU  know 
that  such  questions  are  impossible  of  satisfactory  answer,  owing 
to  the  manner  in  which  a  bullet  is  diverted  in  its  course  b}'^  the 
various  tissues  of  the  body,  it  will  nevertheless  create  a  good 
impression  as  to  the  thoroughness  and  exactness  of  an  exami- 
nation should  it  be  brought  out,  in  answer  to  questioning,  that 
this  had  been  done.  Many  an  excellent  surgeon  has  been  sur- 
prised upon  the  stand  by  the  question  from  one  of  the  counsel 
as  to  whether  he  knew  that  some  certain  writer  had  stated  that 
it  was  always  well,  in  trying  to  determine  the  course  and  direc- 
tion of  a  bullet,  to  put  the  patient  or  the  body,  as  the  case  might 


596  GUNSHOT   WOUNDS — PARK. 

be,  in  the  exact  position  in  which  it  was  when  the  shot  was 
fired,  providing  this  be  known.  The  accomplished  surgeon 
knows  that  this  is  a  matter  of  very  trifling  import,  but  the 
witness'  status  will  be  much  better  established  with  the  jury  if 
he  can  show  himself  familiar  with  this  possible  method  of  ex- 
amination. 

When  a  suspected  person  is  brought  before  a  magistrate, 
accused  of  homicidal  attempt,  it  is  very  likely  that  the  judge 
will  require  a  written  statement  or  opinion  from  the  surgeon  in 
attendance  as  to  the  extent  and  danger  of  the  victim's  injuries, 
and  especially  as  to  whether  these  are  of  a  character  dangerous 
to  life.  The  meaning  of  these  words  is  left  entirely  to  the 
sagacity  of  the  surgeon.  A  mere  naked  declaration  of  this  fact 
is  insufificient.  He  must,  if  called  upon  by  the  court,  give  his 
grounds  for  his  belief,  and  these  may  be  rigorously  examined  by 
counsel.  He  will  also  probably  be  asked  as  to  the  presumable 
duration  of  life  and  possibly  the  effect  of  operation.  Thus  the 
prisoner's  immediate  liberty  or  restraint  may  depend  upon  the 
surgeon's  words.  Perhaps  the  only  advice  which  can  be  offered 
here  is  to  qualify  between  injuries  directly  dangerous  to  life  and 
those  in  which  life  is  endangered  merely  by  possible  complica- 
tions, such  as  sepsis,  gangrene,  etc.  Still,  aside  from  wounds 
which  are  either  fatal  or  may  be  nearly  completely  recovered 
from,  there  is  another  quite  large  class  of  those  causing  griev- 
ous bodily  harm  in  which  it  is  a  question  for  the  jury  always 
to  decide  what  was  the  intent  of  the  accused.  A  medical  wit- 
ness may  thus  in  such  a  case  be  of  great  assistance  to  the  court 
by  giving  an  account  of  the  injury  devoid  of  technicalities,  and 
of  its  possible  consequences.  It  should  also  always  be  stated, 
if  known,  whether  the  patient  was  under  the  influence  of  liquor 
or  any  narcotic  at  the  moment  of  injury. 

In  the  examination  of  wounds  either  of  the  living  or  dead 
body,  it  should  always  be  determined  for  medico-legal  purposes 
whether  there  is  about  them  fluid  or  coagulated  blood  or  ecchy- 
mosis,  that  is,  livid  discoloration  of  the  skin  from  effused 
blood.  The  color  of  the  ecchymotic  spot  will  give  a  valuable 
clew  as  to  the  time  between  the  infliction  of  the  wound  and 
death.  Putrefaction  of  such  a  wound  must  not  be  mistaken 
for  gangrene.  In  giving  reports  on  such  cases  care  should  be 
taken  to  distinguish  between  facts  and  inferences.     In  fact, 


EXAMINATION   AND    DESCRIPTION.  597 

the  inferences  had  better  be  kept  unreported  or  confined  to  a 
separate  statement. 

Should  there  be  any  possible  suspicion  of  a  combination  of 
poisoning  and  gunshot  wound,  the  stomach-contents  should  be 
carefully  preserved  and  sealed  up  in  the  presence  of  witnesses 
before  turning  over  the  same  to  the  analytical  chemist,  whose 
receipt  for  the  package,  with  a  careful  description  of  the  same, 
will  probably  have  to  be  placed  in  evidence.  Any  fact  on  the 
condition  of  the  stomach  with  regard  to  digestion  is  always 
worth  noting.  In  the  case  of  Reg.  v.  Spicer  (Berks  Lent  As- 
sizes, 184G)  a  most  important  point  hinged  on  the  examination 
of  the  stomach.  The  bod}^  was  found  at  the  foot  of  a  stairway. 
The  prisoner  stated  that  after  he  and  his  wife  had  had  their 
dinner  he  heard  a  fall.  The  woman  had  died  instantaneously 
and  the  death  occurred  about  the  dinner-hour.  Upon  exami- 
nation the  stomach  was  found  empty,  without  a  trace  of  food. 
It  was,  therefore,  clear  that  a  part  at  least  of  the  prisoner's 
story  was  untrue. 

Evidence  as  to  whether  the  wounds  were  superficial  or  deep 
may  be  of  value.  If  the  edges  are  swollen  or  large,  or  if  gran- 
ulation or  cicatrization  have  commenced,  it  is  evident  that  the 
person  must  have  lived  some  hours  or  some  days  after  their 
reception.  The  same  is  true  of  suppuration,  adhesion,  or  gan- 
grene. It  must  also  be  remembered  in  this  connection  that  xevy 
few  gunshot  wounds  will  show  much  change  in  less  than  ten  or 
twelve  hours  save  that  due  to  the  extravasation  of  blood. 
Should  the  question  come  up  as  to  whether  a  gunshot  wound 
had  been  inflicted  before  or  after  death,  we  may  remember  the 
principal  characteristics  of  a  wound  inflicted  during  life,  which 
are  more  or  less  eversion,  more  or  less  hemorrhage  with  diffu- 
sion of  blood  into  the  tissues,  and  the  presence  of  clots.  In  a 
wound  made  after  death  little  or  no  blood  is  effused,  unless  it 
come  from  some  vessel  very  near  the  surface,  in  which  case  it 
will  be  venous  in  character  and  will  not  coagulate  as  does  that 
which  is  poured  out  of  a  wound  in  the  living.  The  track  of 
the  bullet  also  will  not  be  found  filled  with  coagula.  In  these 
respects  a  little  will  depend  upon  whether  the  body  has  lost  its 
animal  heat  or  not.  The  gunshot  puncture  of  a  divided  arterj- 
in  a  dead  body  will  present  a  very  different  appearance  from 
one  inflicted  before  death,  even  though  it  be  the  cause  of  death. 


598  GUNSHOT   WOUNDS — PARK. 

Bleeding  after  death  is  exclusively  venous,  and  there  does  not 
occur  extravasation  of  blood  in  the  cellular  tissues,  nor  does  it 
coagulate.  Questions  of  this  character  come  up  sometimes  in 
the  case  of  multiple  wounds  or  injuries,  and  it  is,  at  times,  of 
importance  to  be  able  to  determine  whether  the  assault  or  injury 
has  been  continued  after  death.  Changes  in  color  of  an  ecchy- 
mosed  spot  rarely  begin  until  after  the  expiration  of  twenty- four 
hours,  when  its  dark  margins  become  lighter,  and  as  time  goes 
on  the  whole  area  passes  through  successive  shades  of  violet, 
green,  and  yellow;  its  area  may  also  increase  sometimes  to 
remarkable  proportions,  but  the  central  portions  are  always 
darker  than  the  periphery,  the  darkest  spot  corresponding  to 
the  centre  of  violence.  Ecchymosis  is  longer  in  disappearing 
in  the  old  than  in  the  young.  Its  various  features  also  will 
vary  a  little  in  accordance  with  the  tissues  bruised. 

Gunshot  wounds  pertaining  to  spurious  suicidal  attempts 
are  usually  found  not  to  involve  vital  parts,  while  they  will  have 
most  of  the  characteristics  of  injuries  inflicted  from  a  weapon 
near  at  hand.  The  skin  or  the  clothing  will  show  powder- 
marks,  and  if  a  wad  is  a  feature  of  the  cartridge  used,  it  may 
be  found  in  one  place  or  the  other.  In  these  cases  there  is  also 
relatively  more  laceration  and  bruising,  while  sometimes  the 
hand  which  held  the  weapon  may  be  blackened  or  burnt  by  the 
discharge  of  the  same.  Self-inflicted  wounds,  in  other  words, 
must  necessarily  partake  of  the  character  of  near  wounds. 

EVIDENCE   FROM   THE   SITUATION   OF   THE   WOUND. 

It  has  been  generally  noted  that  suicidal  wounds  are  for  the 
most  part  confined  to  the  front  or  lateral  parts  of  the  body ; 
gunshot  wounds  of  this  character  being  found  usuall}^  in  the 
region  of  the  heart,  the  face,  and  the  temples.  The  presence  of 
an  injury  to  these  parts  is  not  necessarily  indicative  of  suicide, 
but  the  existence  of  such  injuries  in  other  parts  of  the  body  is 
at  least  negative  evidence  of  homicidal  attempt.  Moreover, 
Orfila  has  observed  that  it  is  not  so  much  the  situation  as  the 
direction  of  the  wound  which  gives  evidence  for  or  against  the 
presumption  of  suicide.  The  question  has  been  raised  whether 
it  were  possible  to  have  a  gunshot  wound  without  external  evi- 
dence.    There  has  been  recorded  more  than  one  case  where  a 


EVIDENCE  FROM   THE   SITUATION    OF   THE   WOUND.        599 

bullet  entering  through  the  open  mouth  has  penetrated  the  brain 
without  passing  through  the  vertex  of  the  skull  and  has  killed 
instantly  without  leaving  any  external  mark. 

It  is  very  necessary  to  establish,  if  possible,  the  direction  of 
such  a  wound,  and  this  may  be  coupled  with  a  knowledge  of 
the  right-handedness  or  the  left-handedness  of  the  person  who 
inflicted  it,  or  may  shed  light  in  this  way  upon  some  personal 
peculiarity  which  may  lead  to  the  detection  of  the  guilty  person. 
Thus  it  is  said  of  Sir  Astley  Cooper  that  in  one  instance  he 
remarked  that  a  certain  wound  could  not  have  been  inflicted 
except  by  a  left-handed  person,  and  that  his  observation  led  to 
the  detection  of  the  murderer.  It  has  been  stated  that  for  the 
detection  of  the  weapon  or  instrument  used  it  should  be  placed 
first  in  one  hand  of  the  deceased  and  then  in  the  other,  while 
the  other  extremities  are  so  manipulated  that  it  may  be  clearly 
determined  whether  suicidal  attempt  were  possible  or  no.  There 
is  ordinarily  little  difficulty  experienced  in  distinguishing  sui- 
cidal from  accidental  wounds.  In  the  former  case  extraneous 
signs  and  circumstances  point  more  clearly  to  the  intent  of  the 
deceased  than  do,  perhaps,  the  peculiarities  of  the  wound  itself. 
This  is  to  be  settled  mainly  by  the  evidence  of  those  who  find 
the  bod}^;  in  other  words,  by  circumstantial  evidence. 

In  suicides  ordinarily  one  wound  only  is  met  with.  At  any 
rate,  probably  one  only  that  has  destroyed  life.  Consequently 
the  presence  of  several  wounds,  each  of  which  was  necessarily 
fatal,  constitutes  almost  conclusive  evidence  of  murder,  the 
strength  of  the  same  depending  upon  the  necessary  fatality 
of  more  than  one  of  these.  Thus  it  is  hardly  conceivable  that 
a  suicide  should  shoot  himself  through  the  heart  and  through 
the  brain;  the  coexistence  of  two  such  wounds  would  be  almost 
conclusive  of  homicide.  The  existence  of  multiple  wounds  is  a 
rather  strong  presumption  of  insanit}'  or  drunkenness  of  the 
person  who  inflicted  them.  Men  who  kill  when  under  the  in- 
fluence of  liquor  not  infrequently  inflict  injuries  enough  to  be 
several  times  fatal. 

The  coexistence  of  wounds  made  by  cutting  weapons,  as 
well  as  firearms,  is  not  unknown.  These  are  occasionally  sui- 
cidal, ordinarily  thej"  betoken  murderous  attempt.  If  suicidal 
the  deceased  will  ordinarily  be  found  to  have  been  a  lunatic. 

But  evidence  is  to  be  obtained  also  from  signs  and  circum- 


GOO  GUNSHOT   WOUNDS — PARK. 

stances  separable  from  the  wound  itself.  Thus  the  position  of 
the  body  may  be  such  as  to  invalidate  the  theory  of  accident  or 
suicide.  The  position  of  the  weapon,  too,  is  something  to  be 
noted  with  great  care.  Whether,  for  instance,  this  be  firmly 
held  within  the  hand  of  the  corpse,  or  whether  it  had  been 
simply  placed  there  after  his  death ;  whether  it  be  found  where 
it  would  seem  to  have  been  most  naturally  dropped  after  its 
discharge,  or  found  somewhere  M'here  it  could  scarcely  have 
been  placed  or  thrown  by  the  deceased ;  whether  it  be  found  at 
such  a  point  that  it  is  clearly  evident  from  other  signs  it  could 
not  have  been  dropped  by  the  deceased,  since  death  must  have 
been  caused  too  quickly  for  him  to  have  traversed  the  interven- 
ing space. 

EVIDENCE  FROM  THE  WEAPON  AND   PROJECTILE. 

Evidence  of  great  value  may  be  obtained  often  from  the 
weapon  itself.  First  of  all,  from  the  position  in  which  it  is 
found,  as  stated  above ;  second,  from  a  careful  examination  of 
itself.  It  should  be  noted  whether  there  be  any  blood  upon  it, 
and  whether  this  be  so  fresh  as  not  to  have  caused  any  rust; 
whether  it  may  possibly  be  so  smeared  with  blood  as  to  indicate 
a  hand-to-hand  conflict;  or  whether  any  part  of  the  weapon 
may  have  been  used  as  a  club  or  bludgeon,  as  would  be 
shown  by  the  presence  upon  it  of  hair  entangled  in  dry  blood. 
When  such  blood  is  removed  from  the  weapon  it  should  be 
carefully  examined  with  the  microscope,  since  from  the  detec- 
tion and  identification  of  hair  or  fibres  of  fabric  evidence  of  the 
greatest  value  may  be  adduced.  Next  it  should  be  ascertained 
whether  a  weapon  shows  signs  of  having  been  recently  dis- 
charged or  whether  it  be  evident  that  it  could  not  have  been  so, 
and  such  determination  of  the  time  element  as  ma}^  be  afforded 
by  a  study  of  this  kind  should  be  contrasted  with  that  made 
after  a  study  of  the  wound.  If  the  weapon  be  a  revolver  or 
a  repeating  arm  of  any  kind,  it  should  be  determined  if  possible 
how  man}^  cartridges  or  bullets  have  been  fired,  and  whether  at 
or  about  the  same  time,  and  this  information  should  be  com- 
pared with  the  evidences  obtained  from  the  body  and  from  the 
room  or  localitj^  in  which  the  suicide  or  murder  occurred.  If, 
for  instance,  it  be  determined  that  three  cartridges  have  been 


EVIDENCE    FROM    THE    WEAPON    AND    PROJECTILE.  601 

fired  and  but  two  bullet-wounds  are  found  in  the  body,  an 
examination  of  the  room  may  show  where  went  the  third  bullet. 
Next  the  calibre  of  the  weapon  should  be  noted  and  the  weight 
of  the  ball  which  it  discharged  and  its  dimensions  should  bo 
comjiared  with  any  which  may  be  found  in  or  about  the  body. 
The  weight  of  the  bullets  attached  to  cartridges  of  various  sizes 
and  makes  is  usually  stamped  upon  the  packages  in  which  they 
are  sold,  or  can  readily  be  obtained  from  the  makers  of  the 
same.  A  bullet  taken  from  a  body  weighing  after  its  removal 
more  than  do  the  other  bullets  undischarged  in  the  weapon  by 
which  an  injury  is  alleged  to  have  been  inflicted  i^  rather  pre- 
sumptive evidence  against  the  injurj^  from  that  source. 

Can  a  Bullet  Lose  in  Weight  between  the  Time 
WHEN  IT  Leaves  the  Bore  of  a  Gun  and  its  Discovery 
IN  A  Body? — Here  springs  up  a  question  upon  which  some  very 
interesting  evidence  has  been  adduced  in  different  trials.  To 
discuss  this  matter  completely  the  question  should  be  divided 
into  two,  the  first  being : 

Does  a  Bullet  Suffer  Loss  of  Weight  during  its 
Course  through  the  Piece  and  the  Air  before  it  comes 
IN  Contact  with  the  Body? — A  personal  letter  received  from 
Captain  Charles  Shaler,  of  the  Ordnance  Department  of  the 
United  States  Army,  in  reply  to  certain  questions,  tends  to  fully 
settle  that  a  lead  bullet  suffers  a  certain  loss  of  weight  in  the 
barrel  due  to  the  friction  between  the  bullet  and  the  bore;  this 
is  known  as  "  leading"  and  varies  according  to  circumstances. 
"  Patching"  the  bullet  is  often  resorted  to  in  order  to  reduce  the 
leading;  lubrication  is  also  practised.  The  fusing  of  a  bullet 
takes  place  especially  with  lead  bullets.  A  ball  which  has  been 
partly  fused  in  the  bore  will  lose  the  fused  portions  in  the  bore 
or  in  flight,  and  will  move  irregularly  on  account  of  the  result- 
ing ii'regularity  of  form.  A  .45-calibre,  500-grain  service  bul- 
let, lead  alloyed  with  tin,  was  weighed  without  lubricant  and 
was  found  to  weigh  500.5  grains.  It  was  then  lubricated  in  tlu' 
cannelures  and  was  fired  into  a  butt  composed  of  three  barrels 
placed  end  to  end  and  filled  with  sawdust.  The  bullet  was 
recovered,  no  lubricant  being  found  in  the  cannelures,  and  re- 
weighed,  the  weight  obtained  being  485.5.  The  loss  of  weight 
was,  therefore,  15  grains  or  three  per  cent,  some  of  which  may 
have  been  due  to  the  bullet  penetrating  the  sawdust.     A  Ger- 


G03  GUNSHOT   WOUNDS — PARK. 

man-silver  "jacketed"  .30-calibre  bullet,  weighing  before  firing 
231  grains,  fired  without  lubrication,  when  recovered  and  re- 
weighed  was  found  to  have  suffered  a  loss  of  weight  of  one-half 
grain  or  one-quarter  of  one  per  cent.  The  other  part  of  the 
main  question  is : 

Does  the  Bullet  Lose  in  Weight  in  its  Course 
THROUGH  the  Body? — This  is,  of  course,  intended  to  pertain 
only  to  those  instances  in  which  there  is  no  evidence  of  splitting 
or  division  of  the  bullet,  and  refers  only  to  the  effect  of  friction 
or  attrition.  June  5th,  1878,  in  Saratoga  County,  Mrs.  Jesse 
Billings  was  accidentally  killed  by  a  bullet.  Her  husband  was 
arrested  and  tried  for  murder.  On  the  first  trial  he  was  ac- 
quitted. A  second  trial,  however,  was  held,  and  some  very  in- 
teresting expert  testimony  was  brought  out  on  matters  pertain- 
ing to  these  questions.  The  medical  evidence  is  published  in 
full  bj"  Dr.  Lewis  Balch,  of  Albanj-,  in  the  Transactions  of  the 
Medical  Society  of  the  State  of  New  York  for  1881.  The  rifle 
from  which  the  bullet  was  supposed  to  have  been  fired  was 
found  in  a  well,  and  was  sworn  to  have  belonged  to  Jesse 
Billings.  In  it  was  found  a  cartridge  of  the  type  known  as  the 
Commercial  Long  No.  44.  This  gun  became  an  important 
factor  in  the  case,  and  most  of  the  evidence  as  to  whether  it 
was  the  weapon  with  which  the  murder  had  been  committed 
was  referred  to  the  medical  experts.  The  defence  in  the  first 
trial  claimed  that  all  the  lead  fired  was  found  in  Mrs.  Billings' 
head.  On  the  second  trial  the  same  claim  was  not  made,  but 
that  it  was  a  smaller  bullet  than  a  .44  and  its  weight  less  than 
220  grains;  that  in  consequence  this  rifle  could  not  have  been 
that  from  which  the  shot  was  fired,  for  it  only  called  for  a  .44 
ball,  and  that  it  would  have  thrown  a  bullet  with  such  force 
that  it  must  have  gone  entirely  through  the  head.  They  further 
claimed  that  powder-marks  and  grains  of  powder  were  found 
in  the  window-sash,  showing  that  the  weapon  was  fired  near  the 
window,  and  that  the  hole  in  the  glass  was  not  large  enough 
to  admit  a  full-sized  .44  ball.  The  verdict  was  mainly  won  upon 
these  statements.  A  question  for  the  medical  experts  to  answer 
was,  what  would  be  the  effect  upon  the  skull  of  a  .44-calibre  ball 
fired  from  a  Ballard  rifle,  the  ball  weighing  220  grains  and  the 
charge  of  powder  being  28  grains?  also  what  would  be  the 
effect  upon  the  ball?     Experts  from  the  Ordnance  Corps  and 


EVIDENCE    FROM    THE    WEAPON   AND    PROJECTILE.  603 

from  the  rifle  factories  were  able  to  testify  that  the  bullet  found 
in  Mrs.  Billings'  head  was  originally  a  .44-calibreball;  also  that 
its  markings  showed  the  peculiar  left-handed  twist  used  in 
rifling  this  particular  arm.  The  defence  maintained  that  it 
could  not  have  been  a  .44,  claiming  that  the  hole  in  the  window- 
pane  showed  that.  The  original  window  produced  in  court 
was  no  criterion,  since  from  repeated  handling  the  hole  made 
by  the  bullet  had  become  enlarged  and  changed  in  shape.  Both 
of  the  experts  for  the  defence  believed  that  the  ball  could  not 
make  a  hole  smaller  than  itself  when  passing  through  glass. 
This  necessarily  supposes  that  the  ball  after  being  fired  is  the 
same  calibre  as  before,  which,  as  shown  above,  is  not  always 
the  case.  So  Dr.  Balch  fired  forty- five  rounds  from  the  Billings 
rifle  with  220  grains  of  lead  and  28  grains  of  powder.  The 
shots  were  fired  through  glass  set  in  sashes,  the  glass  being 
28x13^,  double  thick  and  American  make.  The  rifle  was  dis- 
charged at  varying  angles  and  at  distances  varying  from  two 
to  seventy  feet,  and  he  obtained  one  shot  where  the  hole  made 
would  not  admit  a  full-sized  ball.  His  summary  was  as  fol- 
lows : 

Balls  unable  to  pass  through 1 

Balls  partly  passed 3 

Balls  passed 18 

Cartridge  passed 21 

Glass  broken  out 2 

Total 45 

Other  rounds  were  fired  from  a  Colt's  navy  revolver,  old 
stj'le,  .30  calibre,  at  distances  varying  from  ten  to  twenty  feet. 
The  holes  made  were  so  large  that  the  barrels  and  ramrods 
could  be  passed  without  touching.  The  examination  of  the  one 
instance  noted  above  where  the  aperture  in  the  glass  was  smaller 
than  the  ball  is  explained  by  Balch  as  follows :  "  A  ball  conoidal 
in  form,  passing  with  great  velocity,  strikes  glass,  penetrates, 
but  does  not  break  the  glass  at  the  point  of  entrance.  The  point 
struck  is  instantly  disintegrated,  and  so  rapid  is  the  stroke  that 
it  has  not  time  to  call  upon  the  surrounding  particles  for  sup- 
port; hence  the  smallness  of  the  hole.  As  glass  is  made  it 
varies  in  elasticitj'- ;  some  parts  which  are  to  bo  cut  into  panes 
cool  faster  than  others.  A  bullet  striking  the  portion  of  the 
glass  which  has  cooled  quickly  strikes  an  object  which  will 


604 


GUNSHOT   WOUNDS — PARK. 


yield  somewhat  to  the  force;  in  doing  this  a  hole  will  be  made 
smaller  than  if  that  more  brittle  had  been  struck.  Further- 
more, all  rifles  taper  more  or  less  from  breech  to  muzzle,  that 
is,  the  muzzle  will  measure  one  or  more  thousandths  or  hun- 
dredths less  than  the  breech.  The  bullet  being  forced  through 
the  narrow  aperture  yields  to  the  pressure  and  becomes  smaller. 
The  gun  under  consideration  was  measured  at  the  New  York 
Armorj^,  and  found  to  be  .44  at  the  breech  or  chamber  and 
.423  at  the  muzzle.  Considering  these  various  facts,  statements 
that  a  ball  of  known  size  will  make  a  hole  through  glass  smaller 
than  the  size  of  the  ball  when  fired  do  not  admit  of  doubt  as  to 
their  verity.  Some  statements  bearing  on  this  same  point  con- 
tained in  a  recent  letter  from  Captain  Shaler,  of  the  United 
States  Armj^,  deserve  mention  here.  The  following  experiment 
was  made  in  Washington  by  Captain  Lyon  in  October,  1880: 

"  Noticing  a  statement  in  a  newspaper  to  the  effect  that  a 
ball  fired  from  a  rifle  would,  in  passing  through  glass,  make  a 
round  hole  smaller  than  the  diameter  of  the  ball  used,  the  fol- 
lowing experiment  was  made : 

"Service  ammunition  used,  in  a  calibre  .45  Springfield  rifle 
to  penetrate  glass. 


Time  Fired. 

Size  of  Hole  made 
in  Glass,  inches. 

Remarks. 

1 

0.570 

2 

0.550 

3 

0.600 

4 

0.600 

5 

0.575 

6 

0.575 

The    frame    holding    the 

7 

0.590 

glass    was    placed     25 

8 

0.620 

vards  from  the  muzzle 

9 

0.600 

of  the  gun. 

Average  size  of  hole 

0.586 

Calibre  of  bullet 

0.458 

Difference 

0.125 

"  From  the  above  it  will  be  noted  that  there  is  no  uniformity 
in  the  size  of  the  holes  and  that  they  all  exceed  the  diameter  of 
the  bullet. 

"  These  experiments  were  supplemented  by  some  made  re- 
cently in  which  a  sash  containing  six  panes  of  ordinary  window- 


EVIDENCE   FROM   THE   WEAPON   AND   PROJECTILE.         605 

glass  was  placed  at  twenty-five  yards  from  the  firer  and  the 
glass  was  successively  penetrated  (a  separate  pane  being  used 
in  each  case)  by  bullets  from  a  service  .45-calibre  Springfield 
rifle,  a  .30-calibre  Springfield  rifle,  a  .45-calibre  Colt's  revolver 
and  a  .22-calibre  revolver.  In  every  case  the  hole  made  was 
much  larger  than  the  bullet  making  it." 

With  reference  also  to  the  effect  of  a  ball  being  smaller  than 
its  original  diameter  after  it  leaves  the  piece,  Captain  Shaler 
states :  "  All  very  compressible  bullets  forced  by  inertia  lose  a 
certain  amount  even  though  they  also  gain  force  by  slugging. 
Forcing  by  inertia  tends  to  shorten  the  bullet  and  increase 
the  diameter,  while  slugging  tends  to  lengthen  the  bullet  and 
reduce  its  diameter.  Whether  the  bullet  is  smaller  after  it 
leaves  the  piece  depends  upon  the  bullet  used  and  the  method  of 
forcing  employed." 

To  return  to  the  Billings  case,  it  was  claimed  that  the  bullet 
was  also  too  small.  It  weighed  165  grains,  55  less  than  when 
it  was  fired  from  the  rifle.  Balch  found  in  firing  at  human 
skulls,  the  subjects  in  all  the  trials  but  two  being  placed  in  a 
sitting  posture,  sometimes  with  a  sash  like  the  Billings  window 
in  front  of  the  subject,  that  the  ball  lost  lead  in  accordance  with 
the  resistance  it  met  with  and  the  amount  of  bone  ploughed  in 
its  passage.  These  experiments  conclusively  prove  that  the 
weight  of  a  ball  taken  from  a  body  after  being  fired,  it  having 
traversed  a  bone  in  its  flight,  is  b}^  no  means  evidence  of  its 
weight  before  firing ;  in  other  words,  a  ball  always  loses  some 
lead  when  passing  through  bone.  With  the  same  rifle  as  that 
produced  at  the  trial  he  made  a  series  of  experiments  in  the 
dissecting-room,  endeavoring  to  make  a  bullet  enter  the  skull 
at  the  same  point  and  in  nearly  as  possible  the  same  direction 
as  in  the  case  of  the  murdered  woman.  In  six  such  experi- 
ments there  were  var3'ing  losses  of  lead,  all  the  bullets  used 
being  the  same  general  weight.  In  two  trials  the  distance  was 
but  ten  feet  from  the  muzzle,  yet  more  lead  was  lost  than  in 
any  of  the  other  four.  The  least  loss  recorded  took  place  at 
the  longest  distance,  thirty-five  feet.  This  in  part  accounts  for 
the  loss  of  lead,  for  at  ten  feet  the  bullet  has  not  acquired  its 
greatest  penetrating  power,  for  he  showed  bj^  experiment  that 
a  220-grain  bullet  fired  at  a  human  skull  will  lose  more  lead 
than  was  missing  from  the  Billings  bullet,  thus  disposing  of 


606  GUNSHOT   WOUNDS — PARK. 

-the  question  raised  by  the  defence  that  a  ball  could  not  have 
weighed  220  grains  before  being  fired. 

Just  how  to  account  for  the  missing  lead  has  never  been 
clearly  established.  We  have  to  remember  that  a  few  grains 
may  be  left  in  the  bore  of  a  rifle,  especially  if  rust}^ ;  that  in 
passing  through  glass  another  portion  is  lost,  and  finally  it  is 
scarcely  conceivable  that  any  bullet  should  penetrate  an  adult 
skull,  especially  in  the  neighborhood  of  the  mastoid  processes, 
without  losing  quite  a  perceptible  percentage  of  its  mass  by 
friction. 

It  was  also  claimed  by  the  defence  that  the  ball  taken  from 
Mrs.  Billings'  head  had  been  fired  from  a  weapon  of  low  veloc- 
ity, which  was  held  to  account  for  the  fact  that  the  ball  failed 
to  pass  out  of  the  skull.  The  rifle  when  tested  at  the  Govern- 
ment Arsenal  showed  a  mean  velocity  of  999  feet  per  second. 
Had  it  been  as  high  as  was  supposed  by  the  defence,  namely, 
1,300  or  1,400  feet,  the  argument  that  a  bullet  driven  with  this 
force  would  always  go  through  the  skull  would  have  more 
weight,  but  with  the  velocity  found  by  actual  test  the  energy 
of  the  ball  was  lessened  to  nearly  one-half  of  that  supposed. 
The  bullet  which  killed  Mrs.  Billings  did  not  pass  entirely 
through  the  skull.  It  ploughed  into  the  opposite  side  and  broke 
before  it  a  triangular  piece  of  bone  which  broke  the  skin  exter- 
nally. This  shows  the  resistance  of  external  fascia  against  per- 
foration. A  study  of  the  lines  of  fracture  in  this  particular 
case  proved  very  interesting,  but  perhaps  would  be  somewhat 
irrelevant  here.  A  measurement  of  the  skull  and  of  the  bullet- 
track  through  it  shows  the  former  to  have  been  of  more  than 
ordinary  thickness  and  density,  and  the  channel  ploughed  in  the 
bone  by  the  bullet  along  the  base  of  it  to  have  been  nearly  two 
inches  in  length.  Dr.  Balch  gives  the  following  conclusions 
to  his  very  interesting  evidence :  1st.  A  leaden  ball  passing 
through  bone  loses  lead  in  proportion  to  the  amount  of  bone 
traversed.  2d.  If  the  petrous  portion  of  the  temporal  bone  be 
the  part  struck  by  the  ball  and  struck  squarely  at  the  base, 
that  portion  of  the  bone  is  crumbled  or  broken  in  such  exceed- 
ingly'' fine  pieces  as  to  defy  restoration.  3d.  That  if  the  ball 
struck  any  part  of  the  skull  the  petrous  portion  will  be  broken, 
but  can  be  usually  recognized  and  generally  put  together  again. 
4th.  That  a  ball  of  given  calibre  fired  through  glass  may  make 


EVIDENCE   FROM    THE    WEAPON    AND    PROJECTILE.         607 

a  hole  enough  smaller  than  the  full  size  of  the  ball  before  firing 
to  prevent  an  unfired  ball  of  like  calibre  passing. 

In  all  this  kind  of  experimentation  upon  cadavers  for  the 
purpose  of  eliciting  evidence  by  reproducing  as  nearly  as  possi- 
ble ante-mortem  injuries,  we  must  not  forget  that  Casper  has 
strongly  insisted  that  "  it  is  extremely  difficult  to  break  up  the 
organic  cohesion  of  dead  organs.  ...  If  we  endeavor  to  frac- 
ture the  skull  of  a  dead  adult  we  shall  find  that  an  amount  of 
force  which  if  applied  in  life  would  indubitably  produce  fissures 
if  not  fracture,  or  complete  crushing  of  the  skull,  leaves  the 
dead  skull  quite  uninjured.  .  .  .  The  most  powerful  blows 
struck  down  upon  the  body,  laid  down  horizontally,  were  with- 
out result,  and  only  after  repeated  violent  blows  were  we  able 
to  produce  perhaps  one  or  a  few  fissures  in  the  occipital  or 
parietal  bone,  or  in  the  temporal  bone  (squamous  portion),  and 
usually  in  the  latter.  We  were  unable  to  produce  more  consid- 
erable effects,  such  as  complete  smashing  of  the  skull  or  fissures 
of  its  base,  even  in  one  single  instance.  The  dead  skull  seems 
to  have  considerably  more  power  of  resistance,  and  after  its 
removal  fissures  of  the  bone  were  more  easily  produced  by  simi- 
lar blows"  (Vol.  I.,  p.  245).  And  again:  "The  result  of  my 
experiments  on  the  dead  body  in  regard  to  gunshot  wounds 
could  only  be  to  make  more  complete  the  proof  of  the  resistance 
of  the  dead  corporeal  tissues,  in  contradistinction  to  the  tissues 
wheix  d-live.  After  I  had  already  learned  this  peculiarity  from 
my  experiments  with  contused  wounds,  this  peculiar  resistent 
property  was  found  to  be  confirmed  in  a  most  remarkable 
manner"   ("Forensic  Medicine,"  Vol.  I.,  p.  271). 

If  the  number  of  bullets  known  to  have  been  fired,  or,  more 
important  still,  which  have  been  found  exceeds  the  number 
which  could  have  been  discharged  from  the  weapon  in  ques- 
tion, a  very  large  element  of  doubt  and  uncertaintj"  is  introduced 
which  must  be  quieted  by  other  and  more  circumstantial  evi- 
dence. Should  two  different  weapons  be  in  question,  it  is  very 
necessary  to  establish  from  which  of  them  the  bullets  have  been 
discharged.  This  can  be  done  mainly  by  weight  and  evident 
calibre  of  the  bullets,  or  some  other  peculiarity;  possiblj^  in 
disputed  cases  even  by  analysis  of  the  metal. 

Wounds  by  Shot-Guns. — In  most  of  what  has  been  said 
it  has  been  supposed  that  the  injury  has  been  inflicted  by  an 


60S  GUNSHOT   WOUNDS— PARK. 

arm  of  the  kind  commonly  described  under  the  terms  pistol, 
revolver,  or  rifle.  Gunshot  wounds  are,  however,  occasionally 
inflicted  with  shot-guns  and  a  charge  of  shot  varying  in  size 
from  small  bird-shot  up  to  that  generally  known  as  buck-shot. 
It  is  characteristic  of  such  missiles  that  they  separate  after 
their  discharge  from  the  gun,  and  a  determination  of  the  degree 
of  their  separation  is  approximately  a  determination  of  the  dis- 
tance of  the  mark  from  the  muzzle  of  the  weapon.  In  suicide 
or  accidental  discharges  of  a  shot-gun  the  muzzle  is  so  near  the 
body  that  the  charge  of  shot  acts  very  much  as  would  a  single 
buUet  of  the  size  of  the  bore  of  the  gun,  and  near  wounds  thus 
inflicted,  wlrile  necessarily  large,  have  about  them  a  minimum 
laceration  and  disturbance  of  tissue,  so  that  perhaps  only  by 
their  size  could  one  say,  viewing  the  wound  alone,  that  the 
weapon  used  had  been  a  shot-gun.  On  the  other  hand,  at  a 
distance  of  a  few  feet  the  shot  begin  to  separate  to  such  an 
extent  that  there  is  much  more  laceration  of  tissue,  and  after 
separation  to  an  indeterminate,  because  variable,  number  of 
feet  we  get  such  marks  as  individual  shot  may  make.  This 
distance  is  indeterminate  because  it  is  predicated  on  the  size 
of  the  gun,  the  dimensions  of  shot,  and  the  weight  of  the 
charge  of  powder.  The  writer,  for  instance,  has  recently  seen 
one  case  where  the  muzzle  of  the  gun  could  not  have  been  more 
than  two  feet  away  from  the  surface  of  the  foot  at  which  it  was 
discharged,  the  consequence  being  a  round  and  very  slightlj" 
ragged  hole  through  the  mid-tarsal  region  from  dorsum  to  sole. 

It  is  possible  for  a  single  grain  of  shot  to  produce  death.  Such 
a  case  is  related  by  Ollivier  d' Angers :  a  thief  scaling  a  wall 
received  at  a  distance  of  fifteen  paces  a  charge  of  shot  from 
a  fowling-piece;  he  fell  dead  immediately.  The  charge  had 
struck  him  in  the  breast,  centring  over  a  space  of  three  or  four 
inches,  but  one  shot  had  penetrated  the  aorta  over  the  attach- 
ment of  the  sigmoid  valves,  and  another  had  traversed  the  en- 
tire wall  of  this  vessel. 

Powder-Marks. — A  very  important  part  of  evidence  in 
case  of  near  wounds  of  gunshot  character  pertains  to  the  pow- 
der-marks upon  the  clothing  and  skin.  Naturally  every  one 
knows  that  when  a  weapon  is  discharged  near  a  given  surface 
there  will  be  more  or  less  powder-marking  upon  that  surface,  the 
same  being  due  to  particles  of  gunpowder  which  are  incom- 


POWDER-MARKS— DIMENSIONS    OF    PEKFORATIOXS.  GO.!) 

pletely  or  not  at  all  consumed,  and  which  are  black  because  of 
the  charcoal  they  contain ;  but  the  circumstances  under  which 
powder-marks  of  a  given  character  can  be  inflicted  are  so  ex- 
tremely variable  that  no  statistics  or  information  of  value  in  a 
general  way  can  be  given.  Thus  the  fineness  of  the  marks  will 
depend  upon  the  fineness  of  the  powder,  and  the  area  covered  and 
the  depth  of  the  marking  upon  the  same,  upon  the  distance  of 
the  muzzle  from  the  surface ;  and  the  only  way  to  make  out  the 
exact  distance  of  the  muzzle  from  the  surface  at  the  time  of  the 
infliction  of  a  given  wound  is  to  use  the  same  weapon,  if  possi- 
ble, with  cartridges  or  charges  out  of  the  same  lot  as  that  used 
at  the  time  of  injury.  Distances  could,  perhaps,  «be  stated  in 
round  numbers,  but  their  value  would  only  be  remotely  approx- 
imate, and  in  a  given  case  the  best  evidence  is  to  be  obtained 
by  experiment  with  the  fire-arm  in  question. 

Dimensions  of  Perforations. — Atdifl^erenttimesa  great 
deal  of  weight  has  been  attached  to  the  dimension  of  the  per- 
foration through  such  objects  as  wood,  glass,  or  even  through 
the  bones  of  the  body,  made  by  the  bullet  which  is  supposed  or 
known  to  have  destroyed  life.  Wrong  inferences  have  been 
drawn  sometimes  from  a  study  of  undischarged  bullets  or  car- 
tridges similar,  at  least  before  firing,  to  that  which  has  been 
taken  from  a  given  body.  It  has  been  stated,  for  instance,  that 
such  a  bullet  was  too  large  to  have  passed  through  such  an 
aperture  or  to  have  made  such  a  hole,  or  that  it  was  so  much 
smaller  than  a  certain  hole  that  it  was  not  the  particular  mis- 
sile which  made  that  perforation.  Upon  this  matter  has  hinged 
a  great  deal  of  uncertainty  and  consequently  a  good  deal  of 
study.  The  size  of  opening  which  a  bullet  of  given  calibre  will 
make  through  wood  depends  upon  the  distance  of  the  weapon, 
the  firing  charge,  the  velocity  of  the  bullet,  the  extent  to  which 
its  shape  has  been  altered  by  passing  through  the  given  barrier, 
by  the  heat  of  the  explosion,  by  the  im})act  of  the  air  upon  the 
heated  and  consequently  softened  metal,  and  by  the  density  and 
thickness  of  the  wood,  as  well  as  by  the  resistance  which  it 
may  have  offered  mainly  from  its  being  fixed  in  place  or  mova- 
ble. There  is,  however,  ordinarily  less  question  about  the  size 
of  a  similar  hole  through  a  piece  of  glass  or  bone.  It  is  gen- 
erally supposed  that  a  bullet  passing  through  a  window-pane 

will  shatter  it.     This  depends,  however,  mainlv  upon  the  per- 

3<J 


GIO  GUNSHOT  WOUNDS — PARK. 

fection  of  fixation  of  the  glass  in  its  resting-place.  If  for  pur- 
poses of  experiment  panes  of  glass  be  tacked  into  a  shutter  and 
bullets  be  fired  at  them  from  varying  distances,  they  will  be 
practically  invariably  shattered.  It  is,  however,  quite  different 
if  the  pane  of  glass  be  firmly  fixed  in  a  frame  by  means  of 
putty  which  has  become  old  and  hard,  and  especially  if  the 
window-frame  itself  be  closely  fitted  in  the  casing.  Under 
these  circumstances  a  bullet  will  often  make  a  clearly  punched 
hole,  or  one  with  very  few  radiating  lines  of  fracture.  Experi- 
ment, therefore,  to  secure  evidence  should  be  made  under  cir- 
cumstances exactly  parallel  to  those  which  necessitate  such 
evidence. 

EVIDENCE   FROM   EXAMINATION   OF   THE  DEAD  BODY. 

Fractures. — Considerable  evidence  of  great  interest  with 
respect  to  the  effect  of  a  bullet-wound  upon  the  skull  and  the 
possibility  of  fractures  being  produced  at  the  base  by  contre 
coup  will  be  found  in  the  statement  of  the  case  of  The  People?;. 
Elisha  B.  Fero,  published  by  Dr.  Charles  T.  Porter,  of  Albanj-, 
in  the  Journal  of  Psychological  Medicine,  April,  1870.  Mrs. 
Fero  was  murdered  while  in  her  bed  and  was  found  to  have 
been  bruised  about  the  head  and  body,  her  husband  claiming 
that  the  deed  was  that  of  a  robber  who  had  attacked  them  both. 
He  was  found  with  slight  bruises  or  scratches  about  the  face 
and  black  marks  as  if  from  burnt  powder  between  the  middle 
fingers  of  his  right  hand.  The  first  autopsy  appears  to  have 
been  carelessly  made,  but  a  flattened  conical  ball  weighing 
twenty-six  and  one-half  grains  was  found  lodged  in  the  middle 
of  the  right  cerebral  hemisphere.  It  had  not  gone  completely 
through  the  brain.  Its  base  fitted  the  shells  of  the  metallic 
cartridges  used  in  Fero's  revolver.  Eight  days  after  death  a 
second  examination  was  made,  after  which  the  head  was  re- 
moved and  preserved  in  95,^  alcohol.  A  theory  of  the  prosecu- 
tion was  that  Mrs.  Fero  was  murdered  by  her  husband ;  that  he 
shot  her,  as  well  as  struck  her  numerous  blows  upon  both  sides 
of  the  head  and  its  front  and  back  with  some  broad,  heavy, 
and  elastic  body,  making  fractures  found  on  autopsy.  Not  the 
least  interesting  part  of  the  testimony  is  that  referring  to  the 
condition  of  tissues  alleged  to  have  been  bruised  after  long 


EVIDENCE  FROM  EXAMINATION  OF  THE  DEAD  BODY.        611 

preservation  in  alcohol.  The  expert  testimony  in  this  case 
appeared  to  show  that  such  fractures  as  were  found,  without 
reference  to  the  fact  of  external  bruises,  were  due  to  the  unskil- 
ful manner  in  which  the  skull-cap  was  removed.  In  this  con- 
nection it  is  well  right  here  to  emphasize  the  fact  that  fresh 
fractures  can  be  produced  in  the  skull  by  too  forcible  or  injudi- 
cious efforts  to  remove  the  calvarium  when  making  autopsies, 
or  that  fractures  previously  existing  can  be  extended  or  compli- 
cated in  the  same  way.  Shaw  in  his  "Manual  of  Anatomy" 
says :  "  The  question  whether  there  has  been  a  fracture  of  the 
cranium  previous  to  death  is  sometimes  more  difficult  to  decide 
than  a  person  not  accustomed  to  make  dissections  might  imag- 
ine. If  the  fracture  has  occurred  immediately  before  the  patient's 
death,  there  will  be  found  coagulated  blood  upon  the  bones  and 
in  the  fissures.  If  the  patient  has  survived  for  some  time,  there 
will  be  marks  of  inflammation  and,  perhaps,  pus  in  contact 
with  the  skull,  but  if  a  fracture  has  been  made  in  making  the 
examination,  which  sometimes  happens  in  even  very  careful 
dissectors'  hands,  the  blood  in  the  fracture  will  not  be  coagu- 
lated, nor  will  there  be  any  effusions  around  the  portions.  In 
Beck's  Medical  Journal,  Vol.  XXII.,  p.  28,  Mr.  Alcock  some 
time  since  stated  in  a  public  lecture  in  London  that  he  had  known 
a  fracture  of  the  base  of  the  skull  produced  by  the  awkward  and 
violent  tearing  of  the  upper  portion  by  the  saw  in  penetrating 
enough  to  divide  the  bones,  and  this  to  be  mistaken  by  the 
inexperienced  operator  for  fracture  of  the  skull  producing  death. 
Being  a  medico-legal  case,  it  might  have  led  to  melancholy 
consequences  had  not  the  error  been  detected  by  an  observer." 
That  an  extensive  and  often  complicated  fracture  by  contre 
coup  can  occur  as  the  result  of  gunshot  injuries  of  the  skull  is 
a  fact  well  known  to  all  surgeons  of  experience  and  laid  down 
in  all  text-books  and  illustrated  in  all  large  museums. 

In  view  of  these  well-known  facts,  it  would  always  bo  well 
to  insist  in  cases  of  this  kind  that  the  saw  alone  should  be  used 
and  not  the  hammer  nor  the  chisel.  When  a  cranial  bone  is 
fractured  blood  is  poured  out  from  the  ruptured  vessels,  as  is 
always  the  case  with  any  bone.  Its  amount  varies  indefinitely 
with  the  number  and  size  of  the  ruptured  vessels,  the  activity 
of  circulation,  the  length  of  time  a  person  lives,  etc.  The  blood 
maj'  collect  in  circumscribed  masses  or  become  infiltrated  in 


G12  GUNSHOT   WOUNDS — PARK. 

the  surrounding  tissues,  although  usually  both  phenomena  are 
observed.  The  extent  to  which  infiltration  takes  place  depends 
upon  the  quantity  of  blood  and  the  nature  of  the  surrounding 
tissues.  In  loose  tissues  like  those  about  the  orbit  infiltration 
is  much  more  rapid  and  extensive. 

Examination  of  the  "Weapon. — French  medical  jurists 
have  tried  to  indicate  how  we  may  determine  the  time  elapsed 
between  the  death  of  a  person  and  the  discharge  of  a  weapon 
found  near  the  body,  but  exact  statements  in  this  matter  are 
utterly  out  of  the  question.  Certain  facts  bearing  on  the  sub- 
ject are  these :  When  recently  discharged  there  will  be  found 
adhering  to  the  barrel  of  the  piece  and  consisting  of  the  fouling 
of  which  sportsmen  complain,  a  quantity  of  potassium  sulfid 
mixed  with  charcoal.  This  is  shown  by  its  forming  a  strong 
alkaline  solution  Avith  water,  evolving  an  odor  of  hydrogen 
sulfid,  and  a  dark  precipitate  with  a  solution  of  acetate  of  lead. 
Depending  upon  the  degree  of  exposure  to  air  and  moisture, 
after  some  hours  or  days  this  sulfid  becomes  converted  into 
potassium  sulfate,  which  forms  a  neutral  solution  with  water 
and  gives  a  white  precipitate  with  acetate  of  lead ;  but  if  a  con- 
siderable time  has  elapsed  since  the  discharge  of  the  piece  oxid 
of  iron  (iron  rust)  with  traces  of  sulfate  may  be  found  {Ann. 
cV Hygiene,  ISS-t,  p.  458;  1837,  p.  197;  184-2,  p.  308). 

Was  the  Weapon  Fired  from  a  Distance  or  Near 
By? — A  gunshot  injury  from  a  bullet  implies  at  least  one 
wound,  namely,  that  of  entrance,  and  perhaj^s  another,  that  of 
exit.  It  does  not  always  happen  that  the  bullet  passes  through 
the  body.  The  appearance  of  the  wound  of  entrance  is  usuall}' 
one  of  irregular  circular  puncture,  its  edges  perhaps  slightly 
torn  or  lacerated,  with  a  purplish  or  dark  areola,  varying  in 
width  from  a  line  or  two  to  one-half  inch.  When  the  weapon 
is  fired  close  to  the  body. there  are  likely  to  be  more  or  less 
powder-marks,  and  possibl}"  actual  burning  from  the  heat  and 
flame  of  the  gunpowder.  If  the  part  of  the  body  injured  had 
been  covered  by  clothing  at  the  time,  the  marks  of  powder  and 
of  burning  would  probablj"  be  confined  to  the  same.  Bleeding 
is  usuall}"  slight  and  occurs  more  commonly  from  the  wound  of 
entrance  than  from  that  of  exit.  Regularity  of  either  of  these 
wounds  depends  in  large  measure  upon  the  angle  at  which  the 
bullet  has  struck  the  surface.     When  striking  very  obliquely 


EXAMINATION    OF    THE    WEAPON — POWDER-MAKKS.        G13 

the  wound  may  be  more  oval  or  the  buhet  may  have  ploughed 
a  furrow  or  a  channel,  b}' a  study  of  which  the  relative  position 
of  the  assailant  and  the  assailed  at  the  moment  of  injury  may, 
perhaps^  be  determined.  It  is  of  importance  to  determine  if 
possible  the  approximate  distance  at  which  the  bullet  was  fired, 
since  the  question  of  self-defence,  fcr  instance,  may  hinge  upon 
evidence  of  this  character.  The  charge  of  powder  and  the 
weight  of  the  bullet  being  known,  one  may  sometimes  estimate 
this  distance  by  the  depth  of  penetration  or  the  appearance  of 
the  bullet.  Still,  the  nature  of  the  tissues  must  figure  largely 
in  such  consideration.  Manj^  suicides  who  shoot  themselves  in 
the  head  show  only  one  wound  of  entrance  and  none  of  exit. 

Experiments  Testing  Pcwder-Marks. — Powder-marks 
and  burns  from  weapons  ordinaril}'  used  will  scarcely  appear 
when  the  distance  has  exceeded  ten  or  twelve  feet.  LaChese,  of 
Antwerp,  found  that  in  firing  a  gun  even  from  a  distance  of 
only  four  feet  the  skin  was  only  partiallj"  blackened. 

As  the  result  of  experiments  made  with  a  Ballard  rifie,  old 
style,  .4:4:  calibre,  with  bullets  of  220  grains  and  28  grains  of 
powder.  Dr.  Balcli,  of  Alban}-,  found  that  powder-marks  were 
made  at  distances  as  follows : 

At  two  feet,  particles  too  numerous  to  count,  with  some  of 
the  lubricant  blown  upon  the  board ; 

At  four  feet  the  same ; 

At  six  feet  the  same ; 

At  eight  feet,  nine  grains  of  powder ; 

At  ten  feet,  five  grains  of  powder  in  one  case  and  six  in 
another. 

That  these  were  powder-grains  were  shown  in  court  by 
picking  some  of  them  out,  placing  them  on  a  glass,  and  igniting 
them  with  a  galvano-caustic  point.  From  those  at  ten  feet  no 
distinct  flash  could  be  elicited  ;  from  those  obtained  at  eight  feet 
distinct  flashes  were  seen  (Trans.  New  York  State  Med.  Soc, 
1881). 

In  the  celebrated  case  of  Peytle,  brought  in  1839  for  the 
murder  of  his  wife,  who  had  been  killed  by  two  buflets  entering 
near  the  nose,  the  eyebrows,  lashes,  and  lids  were  completely 
burned,  and  a  large  ninnber  of  powder  grains  were  imbedded 
in  the  cheeks.  Experiments  being  made  in  order  to  ascertain 
the  distance  necessary  to  produce  these  effects,  it  was  found 


G14  GUNSHOT   WOUNDS — PARK. 

that  the  weapon  must  have  been  held  within  a  distance  of 
twelve  inches. 

Wounds  of  Entrance  and  of  Exit. — A  great  deal  has 
been  written  in  time  past  about  the  peculiarities  of  the  wounds 
of  entrance  and  of  exit,  much  of  which  cannot  be  maintained 
under  expert  criticism.  It  is  true  that  the  wound  of  entrance 
will  usually  be  well  defined,  the  skin  slightly  depressed  and 
appearing  as  above  noted.  It  is  true  also  that  powder-marks 
will  appear  about  this  wound  rather  than  that  of  exit.  Usually, 
too,  the  orifice  of  exit  is  larger,  less  regular,  its  edges  everted 
slightly,  with  more  or  less  laceration  of  the  skin,  and  quite 
free  from  any  powder-marks  or  evidence  of  burning.  The  de- 
pression at  the  border  of  the  wound  of  entrance  differs  after 
some  days,  by  which  time  the  contused  margins  slough  away, 
and  its  appearance  is  daily  changed  by  a  process  of  granulation 
providing  the  individual  recover  or  live  long  enough.  Accord- 
ing to  Dupuytren,  the  hole  in  the  clothing  is  smaller  than  that 
made  by  the  same  buUet  in  the  skin.  These  are  all  points 
worth  remembering  when  fitting  bullets  into  wounds  which 
they  are  supposed  to  have  made ;  but  the  conditions  under  which 
gunshot  punctures  occur  are  constantly  varying,  and  the  sig- 
nificance of  local  markings  is  mainly  the  product  of  experience, 
care,  observation,  and  reasoning.  Thus  the  shape  of  either  of 
these  wounds  will  depend  naturally  upon  the  integrity  of  the 
bullet  and  its  original  shape  and  dimensions.  Matthysen's 
experiments  give  the  following :  A  pistol  fired  at  twelve  paces 
distance,  with  a  ball  15  mm.  in  diameter,  made  a  wound  in 
chest  of  8|  mm.  diameter,  and  at  its  point  of  exit  at  the  back 
one  of  10  mm.  In  two  experiments  at  the  same  distance 
as  above,  the  entrance  wound  was  4  mm.  larger  in  diameter 
than  that  of  exit,  and  when  a  larger  ball  with  a  diameter 
of  17  mm.  was  used  the  same  results  were  preserved,  both 
wounds  being  less  in  size  than  the  ball  which  made  them.  A 
spherical  ball  will  usually  cause  more  loss  of  substance  than  a 
conical,  while  the  latter  will  cause  usually  more  irregularity  of 
outline  and  may  even  give  the  wound  of  entrance  a  slit-like 
appearance.  Complications  may  also  occur  from  other  sources ; 
a  single  wound  of  entrance  may  give  rise  to  two  or  more  wounds 
of  exit  due  to  splitting  of  the  bullet,  or  if  the  bullet  have  been 
divided  and  the  larger  part  lodged  in  the  bone,  only  the  smaller 


COURSE   OF   THE   PROJECTILE.  G15 

portion  passing  out,  the  wound  of  exit  may  in  reality  be  much 
smaller  than  that  of  entrance.  Again,  a  bullet  may  split  into 
fragments  before  striking  the  body,  and  of  these  one  may  enter 
the  body,  or  one  or  more  of  them  lodge.  Multiple  wounds  are 
possible  even  from  one  bullet,  as  when  it  passes  through  two 
different  parts  of  the  body.  Again,  when  two  wounds,  for  in- 
stance, are  discovered,  one  of  them  maj^  be  regarded  as  that  of 
exit,  when  in  reality  they  may  be  two  wounds  of  entrance, 
neither  bullet  having  left  the  bodj^.  So  while  it  is  possible  in 
some  cases  to  decide  which  is  which,  too  much  dependence 
should  not  be  placed  upon  appearances  of  this  kind,  least  of 
all  until  after  a  careful  autopsy  has  been  made. 

Course  of  the  Projectile. — When  a  bullet  traverses  a 
body  the  two  apertures  may  be  nearly  opposite  to  each  other, 
although  the  bullet  may  not  have  taken  a  direct  course  between 
them,  having  been  deflected  by  tissues  of  varying  density  in  its 
course.  This  leads  to  the  mention  of  the  effect  of  animal  tissues 
upon  the  course  of  bullets,  with  which  works  on  militar}"  surgery 
deal  extensivelj'. 

The  following  is  a  remarkable  illustration,  yet  authentic,  of 
a  devious  path  of  a  ball.  In  a  duel  with  pistols  between  two 
students  at  Strasburg  one  fell,  apparently  mortally  wounded  in 
the  neck,  but  recovered  without  feeling  an}"  inconvenience  from 
his  wound.  It  was  found  that  the  bullet  had  strnck  the  larj^nx 
and  had  gone  completely  around  the  neck.  It  was  taken  out 
by  simply  making  an  incision  over  it.  Other  instances  may  be 
cited  where  bullets  have  made  a  circuit  around  the  head,  thorax, 
or  abdomen.  The  ball  may  make  a  half  circuit  of  the  bodj^  and 
lodge  or  emerge  at  a  point  opposite  that  at  which  it  entered, 
thus  leading  one  to  suppose  that  it  must  have  passed  directly 
through  (Wharton  and  Stille). 

As  the  writer  of  a  chapter  on  the  effect  of  projectiles  of  small- 
arms,  in  the  Third  Surgical  Volume  of  the  "  Medical  and 
Surgical  History  of  the  War  of  the  Rebellion,"  p.  709,  says: 
"  Such  bullets  attain  great  range  and  effectiveness  as  oppose  least 
frontage  of  resistance  to  air;  their  velocity  consequently  is 
greater.  Rotation  upon  their  long  axes  tends  to  give  them 
steadier  flight  and  more  direct  course.  By  their  pointed  apices 
they  pierce  more  easily  the  structures  opposed  to  them.  Such 
buUets,  owing  to  the  elasticity  of  the  skin,  make  a  wound  of 


GIG  GUNSHOT   WOUNDS — PARK. 

entrance  perhaps  a  trifle  smaller  in  diameter  than  themselves, 
while  spherical  balls  are  more  likely  to  carry  a  portion  of  the 
integument  in  with  them." 

The  differences  of  structure  and  density  of  the  muscle  tissues 
and  their  aponeuroses  encountered  by  a  bullet  in  its  passage 
materially  influence  the  directness  of  its  course  unless  its  veloc- 
ity be  very  great,  while  round  bullets  are  the  more  easily  de- 
flected from  their  course.  The  track  of  a  small  conical  bullet 
passing  swiftly  through  a  muscle  is  more  cleanly  cut  than  that 
made  by  a  round  bullet,  but  in  all  gunshot  wounds  there  is  usually 
found  a  regular  canal,  with  lacerated  walls,  with  more  or  less 
destruction  along  the  area  of  injury,  shading  off  concentrically 
until  lost  in  healthy  tissue.  There  is  always  loss  of  substance 
dependent  on  muscle  tension  or  direction  of  the  bullet,  whether 
transverse  or  obliquely  to  the  direction  of  the  muscle  fibres ;  the 
more  fibrous  structures  are  torn  and  lacerated  or  simply  per- 
forated, mainly  owing  to  their  different  tension  at  the  instant ; 
their  openings  seldom  correspond  to  those  of  the  muscle  tissues 
or  those  upon  the  surface  of  the  body,  because  of  the  constant 
change  in  the  relation  of  the  parts  due  to  muscle  action.  This 
makes  it  often  difficult  to  follow  the  course  of  a  bullet  with 
accurac}'.  The  irregularity  of  a  bullet-track  due  to  these  causes 
constitutes  one  of  the  great  sources  of  danger,  since  cavities  and 
pouches  thus  formed  give  lodgment  to  foreign  matter  driven  in 
with  the  bullet,  by  retention  of  which  a  fertile  source  of  sepsis 
is  maintained.  Gunshot  injuries  of  bone  may  be  classified  as 
contusions,  simple  fractures,  partial  fractures,  penetrations,  per- 
forations, and  complete  fractures  with  more  or  less  comminution 
or  loss  of  substance,  all  of  these,  of  course,  in  the  surgical  sense 
compound.  These  are  all  manifestations  of  mechanical  force 
acting  in  accordance  with  established  laws.  On  autopsy  these 
will  be  ascertained,  while  one  or  more  portions  or  all  of  a  bullet 
may  be  found  imbedded  in  or  attached  to  some  bone.  The  best 
illustration  of  such  accidents  will  be  found  in  the  "  Medical 
and  Surgical  History  of  the  War  of  the  Rebellion." 

Such  questions  as  pertain  to  the  position  of  the  wounded 
person  when  shot  or  that  of  his  antagonist,  and  other  similar 
inquiries,  can  only  be  settled  by  reference  to  particular  circum- 
stances of  individual  cases.  Position  of  the  wound  may  help  a 
little,     A  bullet- wound  directly  in  the  centre  of  the  top  of  the 


WOUNDS    BY    SMALL    SHOT.  Gl  T 

head  could  scarcely  be  received  by  a  person  standing  unless  his 
assailant  occupied  an  elevated  position.  If  accompanied  by 
evidence  of  severe  blows  by  which  the  deceased  might  have 
been  knocked  down,  it  might  show  that  he  had  been  shot  after 
falling. 

Wounds  by  Small  Shot. — Small  shot  rarely  traverse  the 
entire  body  unless  discharged  from  such  proximity  as  to  make 
a  clean,  round  opening.  Paley  relates  the  following  instance : 
A  boy  was  shot  in  the  neck  by  the  accidental  explosion  of  his 
own  gun,  No.  8  shot.  He  died  instantly.  He  was  lying  for- 
ward of  the  muzzle  so  that  it  was  nearly  in  contact  with  the 
skin  of  the  neck.  A  large  round  hole  was  produced,  in  diame- 
ter one  and  one-half  inches,  whose  edges  were  slightly  darkened 
by  powder.  The  wound  of  exit  at  the  back  of  the  neck,  at  the 
third  vertebra,  was  a  mere  slit  in  the  skin  scarcely  an  inch  in 
length  with  the  diameter  placed  vertically.  The  smallness  of 
this  aperture  may  have  been  owing  to  the  greater  part  of  the 
charge  being  lodged  in  the  body.  Dr.  Lowe  states  that  in  some 
experiments  it  was  found  that  a  round  aperture  might  be  pro- 
duced by  a  discharge  of  small  shot  at  a  much  greater  distance 
than  that  assigned  b}'  Dr.  LaChese,  namel}',  ten  to  twelve 
inches.  Even  admitting  such  exceptional  instances,  it  will 
scarcely  ever  occur  that  a  wound  from  a  small  shot  can  be  mis- 
taken for  one  produced  by  a  leaden  bullet. 

De  Vergie  has  shown  that  when  the  ball  enters  a  portion  of 
the  body  well  covered  with  fat,  this  often  protrudes  between  the 
edges  of  the  wound  and  may  alter  its  character.  If  clothing 
have  been  carried  in  some  shreds  of  it  may  show  upon  the 
wound,  and  such  fragments  of  texture  will  nearh'  alwaj^s 
characterize  the  wound  at  once  as  that  of  entrance. 

Wounds  by  Blank  Charges. — Experience  has  shown 
that  no  matter  with  what  the  piece  is  charged,  it  is  capable, 
when  fired  close  b}^  of  producing  a  wound  which  may  prove  fatal. 
Thus  a  gun  loaded  with  wadding  or  gunpowder  only  may 
cause  death.  A  portion  of  clothing  may  be  carried  into  the 
wound  and  lead  to  death  from  hemorrhage,  or  death  may  occur 
from  many  secondary  causes,  such  as  tetanus  or  sepsis.  Ac- 
cidents so  frequently  occur  from  weapons  discharged  in  sport, 
not  loaded  with  ball  or  shot,  that  it  is  worth  while  to  bear  this 
in  mind.      It  has  been  observed,  for  instance,  that  persons  at- 


618  GUNSHOT   WOUNDS — PARK. 

tempting  to  commit  suicide  have  forgotten  to  put  a  bullet  in 
tlie  pistol,  nevertheless  the  discharge  of  the  weapon  into  the 
mouth  has  sufficed,  from  the  wadding  alone,  to  produce  a  con- 
siderable laceration  and  hemorrhage  (Taylor).  Many  fatal  ac- 
cidents have  taken  place  by  the  discharge  of  wadding  from 
cannon.  LaChese  has  ascertained  by  experiment  that  a  piece 
charged  with  gimpowder  alone  is  capable  of  producing  a  pene- 
trating wound  somewhat  resembling  that  produced  by  gun-shot, 
when  the  piece  is  large  and  fired  within  six  feet  of  the  body 
{Ann.  d' Hygiene,  1836,  p.  368).  This  arises  from  unexploded 
grains  of  powder  acting  as  pellets  of  small  shot.  Sweet  has 
experimented  with  pistols  loaded  with  gunpowder  and  wadding 
in  order  to  determine  the  effect  of  their  discharge  at  different 
distances.  At  twelve  inches  he  found  that  the  clothing  was 
lacerated  and  the  skin  abraded,  but  the  wadding  did  not  pene- 
trate ;  at  six  inches  the  clothes  were  lacerated  and  the  wadding 
penetrated  to  the  depth  of  one-half  inch ;  at  one  and  one-half 
inches  from  the  chest  the  wadding  passed  into  the  thoracic  cavity 
between  the  ribs,  and  at  a  second  experiment  carried  away  a 
portion  of  the  ribs. 

It  is  probable  that  an  ordinary  wadding  such  as  loosely 
wrapped  paper,  rag,  or  similar  material,  especially  as  prepared 
by  one  not  accustomed  to  military  use  of  a  weapon,  would  not 
produce  a  wound  which  would  resemble  that  made  by  a  bullet, 
and  it  is  doubtful  whether  such  a  wound  could  be  produced  at 
a  greater  distance  than  six  inches  from  the  body. 

It  is  on  record  that  in  Paris,  in  1858,  a  circus  cannon  of  four 
inches  bore,  loaded  with  three  ounces  of  grain  powder  retained 
by  a  wad  of  old  theatre  bills  loosely  folded  together  and  rammed 
home  with  only  moderate  force,  was  discharged  in  the  direction 
of  the  boxes  at  a  distance  of  about  one  hundred  and  fifty  feet. 
A  man  seated  in  one  of  these  boxes  opposite  the  muzzle  of  the 
gun,  leaning  forward,  his  arms  crossed  upon  the  handle  of  his 
umbrella,  had  his  arm  broken  above  the  elbow  immediately 
upon  its  discharge.  Several  portions  of  wadding  were  found 
beneath  the  place  where  the  man  sat,  but  no  marks  existed  upon 
his  clothing  nor  upon  the  anterior  part  of  the  arm,  which  must 
have  been  inaccessible  to  any  projectile  that  did  not  first  strike 
the  forearm.  It  was  concluded  that  the  fracture  had  been 
caused  by  the  violent  and  sudden  starting  of  the  man  backward, 


THE   MANNLICHER  RIFLE.  019 

which  must  have  brought  his  arm  against  the  hard  part  of  the 
partition.  An  experiment  tried  with  the  cannon  proved  that 
any  wadding  that  could  be  made  with  paper  was  dispersed  in 
passing,  or  lost  all  power  of  mischief,  at  much  less  distance 
than  one  hundred  and  twenty  feet  {Annales  d^Hygiene,  1859, 
p.  420,  Wharton  and  Stille). 

The  Mannlicher  Rifle. — It  may  be  of  interest  here  to  note 
the  effects  of  the  rifle-bullets  used  in  the  most  recently  invented 
improved  arms.  The  last  new  projectile  used  in  the  German 
army,  1892,  with  the  Mannlicher  rifle,  has  an  inner  core  of  lead 
inclosed  in  a  casing  of  steel  or  firm  metal,  which  prevents  the 
lead,  even  when  softened  by  heat,  from  becoming  deformed  and 
enlarged  by  contact.  The  weight  of  the  bullet  is  much  less  than 
any  of  the  old,  but  to  its  higher  rate  of  velocity  and  its  pointed 
shape,  which  is  preserved,  must  be  ascribed  its  greater  perforat- 
ing power.  Owing  to  this  immense  velocity  and  the  small  sur- 
face of  contact,  it  meets  with  little  resistance  on  striking  a  person, 
has  no  time  to  stretch  the  various  tissues  it  encounters,  causes 
little  or  no  commotion  of  the  neighboring  parts,  and  merely 
punches  a  hole,  carrjnng  the  contused  elements  before  it  clear 
out  of  the  wound  without  seriously  damaging  the  surrounding- 
wall  of  the  bullet-track.  This  absence  of  contusion  must  lead 
to  more  frequent  deaths  from  hemorrhage,  while  when  this  arm 
is  used  we  shall  hear  very  little  of  deflection  or  deviation  of  the 
bullet  from  its  path,  since  it  has  sufficient  power  to  pass  directly 
through  awy  part  of  the  body  which  it  may  meet  on  its  way. 
The  result  in  battle  will  be  a  reduction  of  the  list  of  wounded, 
but  a  terrible  augmentation  of  that  of  the  dead. 

IDENTITY   FROM   A   FLASH   OF   GUNPOWDER. 

Taj'lor  states  the  following:  "  Among  the  singular  questions 
which  have  arisen  out  of  this  subject  is  the  following :  whether 
the  person  who  fires  a  gun  or  pistol  during  a  dark  night  can  be 
identified  by  means  of  the  light  produced  during  the  discharge. 
This  question  was  first  negativel}"  answered  by  a  class  in  phys- 
ical science  in  France,  whereas  later  a  case  tending  to  show 
that  their  decision  was  erroneous  was  subsequently  reported  by 
Fodere.  A  woman  positive!}'  swore  that  she  saw  the  face  of 
the  prisoner,  who  fired  at  another  during  the  night,  surrounded 


-620  GUNSHOT    WOUNDS — PARK. 

by  a  kind  of  glory,  and  that  she  was  thereby  enabled  to  identify 
him.  This  statement  was  confirmed  by  the  deposition  of  the 
wounded  party.  Desgranges,  of  Lyons,  performed  many  experi- 
ments on  this  subject,  and  he  concluded  that  away  from  every 
source  of  light  the  prisoner  who  fired  the  gvm  might  be  identified 
within  a  moderate  distance ;  if  the  flash  were  very  strong,  the 
smoke  very  dense,  and  the  distance  great,  the  person  firing 
the  piece  could  not  be  identified.  The  question  was  raised  in 
England  in  the  case  of  Reg.  v.  White  at  the  Croydon  Autumn 
Assizes,  1839.  A  gentleman  was  shot  at  while  driving  home 
on  a  dark  night,  being  wounded  in  the  leg.  When  he  saw  the 
flash  of  the  gun  he  saw  that  the  piece  was  levelled  toward  him, 
and  the  light  of  the  flash  enabled  him  to  recognize  at  once  the 
features  of  the  accused.  In  cross-examination  he  said  he  was 
quite  sure  he  could  see  the  prisoner  and  was  not  mistaken  as  to 
his  identity;  but  the  accused  was  skilfully  defended  and  he 
was  acquitted.  A  similar  case  was  tried  at  the  Lewes  Lent 
Assizes,  18G3,  Reg.  v.  Stapley.  The  prisoner  shot  at  the  pros- 
ecutor on  a  dark  December  evening,  and  the  latter  swore  that 
he  distinctly  saw  the  prisoner  by  the  flash  of  the  gun  and  could 
identify  him  by  the  light  on  his  features.  His  evidence  was 
corroborated  and  the  man  was  convicted.  A  case  is  also  quoted, 
Rex  V.  Haines,  in  which  some  police  officials  were  shot  at  by 
a  highwayman  during  a  dark  night.  One  of  these  stated  that 
he  could  distinctly  see  from  the  flash  of  the  pistol  that  the  robber 
rode  a  dark-brown  horse  of  remarkable  shape,  and  that  he  had 
since  identified  the  horse  at  a  stable  in  London.  He  also  was 
positive  that  the  prisoner  had  on  a  rough  brown  great-coat. 

There  seems  to  be  enough  evidence  in  this  direction  to  show 
that  identification  under  these  circumstances  is  occasionally 
possible. 

GENERAL  MEDICO-LEGAL  CONSIDERATIONS. 

The  result  of  the  wonderful  advance  in  the  practice  of  sur- 
gery made  during  the  past  fifteen  years  has  been  in  a  large 
measure  to  revolutionize  the  treatment  of  gunshot  wounds,  and 
inasmuch  as  the  result  of  many  homicidal  attempts  will  depend 
in  large  measure  upon  what  the  surgeon  can  do  for  the  victim 
of  assault,  it  may  not  be  amiss  to  very  briefly  epitomize  in  this 
place  something  of  what  modern  surgeons  believe  with  regard 


GENERAL    MEDICO-LEGAL   CONSIDERATIONS.  621 

to  the  best  treatment  of  bullet-wounds,  expressed  in  a  general 
way.  They  have  learned,  among  other  things,  that  the  harm 
which  a  bullet  does  is  done  by  it  during  its  flight,  and  that 
after  it  has  come  to  a  stop  it  is,  per  se,  an  almost  invariably 
harmless  foreign  body.  This  is  practically  always  the  case 
unless  it  has  carried  in  with  it  foreign  material  which  may 
serve  as  a  source  of  septic  infection. 

In  time  past  there  has  always  been  a  strong  feeling,  which 
had,  however,  nothing  scientific  to  justify  it,  that  every  gun- 
shot wound  was  a  poisoned  one.  Of  late,  since  bacteriology 
has  attained  the  proportion  of  a  science,  it  has  been  held  that 
bullets  were  necessarily  sterilized  by  the  heat  of  the  discharge 
of  powder  behind  them.  Very  recently  Dr.  B.  Von  Beck, 
Medical  Director  of  the  14th  German  Army  Corps,  has  made 
experiments  upon  the  amount  of  heat  imparted  to  leaden  and 
other  bullets  after  firing.  After  making  an  allowance  for 
specific  heat  and  the  conductivity  of  the  different  metals  used, 
he  found  that  even  when  the  projectiles  encountered  resistance 
from  three  to  four  times  greater  than  that  offered  by  the  human 
body  the  results  were  as  follows:  Temperature  of  leaden  bul- 
lets of  .45  calibre,  when  recovered,  G9°  C. ;  of  .30  calibre,  covered 
with  steel,  when  recovered,  78°  C";  of  .30  calibre,  covered  with 
copper,  when  recovered,  101°  C.  He  states  that  these  experi- 
ments disprove  the  theory  that  certain  lesions  in  wounds  can 
be  in  any  wa}^  attributed  to  the  heat  imparted  by  the  bullet. 

While  these  experiments  prove  that  the  bullets  may  be  heated 
to  the  above  degrees  when  recovered,  the}'  by  no  means  prove 
that  they  are  so  heated  at  the  time  when  they  inflicted  the 
wound.  During  the  j^ear  1892  some  very  interesting  experi- 
ments were  carried  on  by  Dr.  Lagarde,  of  the  Armj'  Medical  De- 
partment {Neiv  York  Medical  Journal,  Oct.  22d,  1892,  p.  458). 
He  experimented  by  deliberately  infecting  bullets  and  then 
firing  them  into  cotton,  and  animals  as  well,  studying  the  effect 
both  on  the  bullets  themselves  and  upon  the  animals.  Some  of 
these  bullets  were  taken  from  the  original  packages,  while  others 
had  been  intentionally  rolled  in  dirt.  The  experiments  were 
carefully  carried  out  and  appear  reliable,  and  the  conclusions 
given  by  the  author,  which  interest  us  here,  are  as  follows: 

(1)  The  vast  majority  of  cartridges  in  original  packages  are 
sterile  or  free  from  septic  germs  because  of  the  disinfection 


622  GUNSHOT  WOUNDS — PARK. 

and  absolute  cleanliness  observed  in  the  process  of  their  man- 
ufacture. 

(2)  The  majority  of  gunshot  wounds  are  aseptic  because  the 
vast  majority  of  the  projectiles  inflicting  them  are  either  sterile 
or  free  from  septic  germs. 

(3)  The  heat  developed  by  the  act  of  firing  is  not  sufficient 
to  destroy  all  the  organic  matter  of  the  projectile,  the  cherished 
notions  of  three  centuries  or  more  to  the  contrary  notwith- 
standing. 

The  results  as  set  forth  justify  the  assumption  that  a  septic 
bullet  can  infect  a  gunshot  wound.  The  average  bullet-wound, 
however,  is  sterile  so  far  as  infection  from  the  bullet  is  con- 
cerned, and  in  accordance  with  this  view  of  its  usual  innocence 
there  need  be  no  longer  the  clamor  for  removal  of  the  missile 
which  the  fears  of  previous  generations  have  nearly  always 
called  for;  and  the  best  practice  among  military  surgeons 
of  to-day  is  rather  to  let  the  bullet  remain  where  lodged  than 
to  make  a  more  serious  wound  for  its  removal.  Exceptions  to 
this  rule  occur  only  in  cases  where  operation  is  called  for  on 
account  of  injury  done  by  the  bullet  while  still  in  motion.  It 
is  also  held  to  be  a  violation  of  simple  physiological  and  surgi- 
cal rules  to  probe  or  carelessly  search  for  a  bullet  whose  location 
cannot  be  made  out  from  a  study  of  signs  and  symptoms  in 
a  given  case.  The  act  of  probing  breaks  up  blood-clot,  often 
brings  on  fresh  hemorrhage,  is  in  a  majority  of  cases  unsatis- 
factory, frequently  introduces  specific  elements  from  without, 
and  reallj"  gives  little,  if  any,  more  information  than  can  be 
gathered  from  a  stud}^  of  the  case  without  the  use  of  the  probe. 
If  every  ordinary  bullet-wound  which  did  not  call  for  imme- 
diate operation  because  of  injury  to  some  essential  or  vital  part 
— such  as  a  large  blood-vessel  or  nerve- trunk,  or  some  of  the 
viscera — were  antiseptically  and  hermeticalty  sealed  at  the  very 
outset,  there  would  be  a  much  smaller  percentage  of  death  from 
gunshot  wounds,  either  in  civil  or  military  practice,  than  now 
obtains.  And  it  might  be  a  matter  upon  which  to  go  to  the 
jury  whether  violation  of  such  rules,  to-daj^,  does  not  mitigate 
the  offence  of  the  accused. 

Recent  discoveries  in  so-called  cerebral  localization  have 
instigated  numerous  operations  upon  the  skull  and  brain  for 
the  relief  of  pressure,  as  from  blood-clot,  or  for  removal  of  de- 


GENERAL    MEDICO-LEGAL   CONSIDERATIONS.  023 

pressed  bone  or  a  bullet  which  twent}^  years  ago  would  have 
been  impossible.  The  brain  is  no  longer  the  terra  incognita 
of  the  past  generation  of  medical  men,  and  it  is  now  often  pos- 
sible for  the  surgeon  to  intervene  in  such  a  way  as  to  save  life 
in  cases  previously  considered  hopeless;  in  fact,  such  is  now^  his 
duty  when  consent  can  be  gained,  and  it  should  be  held  that  he 
is  culpable  when  deficient  in  general  knowledge  in  this  respect. 

In  wounds  of  the  thoracic  cavity  it  should  now  be  held  that 
so  long  as  air  has  entered  through  a  bullet -w^ound  there  are 
cases  where  free  incision,  even  with  removal  of  ribs,  can 
scarcely  increase  the  dangers,  while  permitting  ojiijortunity 
for  much  more  accurate  exploration  and  determination  of 
life-saving  methods.  The  experiments  of  numerous  investiga- 
tors, the  writer  included,  have  shown  that  bullet-wounds  of  the 
heart  need  not  be  always  and  invariably  fatal,  and  have  afforded 
an  element  of  hope  from  the  possible  surgery  of  even  this  organ. 
The  writer  looks  forward  to  the  time  when  some  accomplished 
yet  daring  surgeon,  getting  the  right  patient  at  the  right  time 
and  in  the  right  place,  i.e.,  where  conveniences  are  at  hand, 
shall,  in  some  case  of  perforating  wound  of  the  pericardium  or 
of  the  heart  itself,  resect  some  portion  of  the  anterior  thoracic 
wall,  lay  open  the  pericardium,  maintaining  meanwhile  artifi- 
cial respiration  if  necessary,  and  suture  a  wound  in  the  heart- 
substance,  thereafter  closing  the  pericardium  and  external 
wound,  and  save  life  which  would  otherwise  be  surely  sacri- 
ficed. With  others  he  has  done  this  upon  animals,  hence  why 
may  it  not  be  done  in  man? 

In  the  mean  time  for,  first,  the  recognition  and,  second,  the 
surgical  treatment  of  perforating  wounds  of  the  abdominal 
viscera,  American  surgeons  have  w^on  for  themselves  the  great- 
est credit,  and  an  already  long  list  of  successful  laparotomies 
after  gunshot  wounds  of  the  intestines,  wnth  intestinal  suture 
or  resection,  has  shown  the  very  great  value  of  this  procedure, 
even  though  it  has  kept  some  would-be  murderers  from  the 
gallows. 

These  lines  are  inserted  here  because  the  time  and  effort 
wdiich  surgeons  have  devoted  to  this  kind  of  surgery  deserve 
only  the  highest  encomiums  and  encouragement  from  the  legal 
profession,  although  to  our  deep  regret  they  have  not  always 
met  with  the  same. 


624  GUNSHOT   AVOUNDS— PARK. 

OF   THE   VARIOUS   CONDITIONS   WHICH   COMPLICATE 
GUNSHOT  WOUNDS  AND  MAKE  THEIR  RE- 
SULTS  UNCERTAIN, 

Delirium  Tremens  is  one  of  the  commonest  and  must 
always  be  regarded  as  one  of  the  most  serious.  It  is  well 
known  to  surgeons  that  a  slight  injury  even,  and  often  a  severe 
one,  is  enough  to  provoke  manifestations  of  this  character  in  in- 
temperate persons.  The  medico-legal  question  under  these  cir- 
cumstances is  this:  Would  the  same  amount  of  injury  have 
been  likely  to  cause  death  in  a  person  of  ordinary  health  and 
vigor?  The  law  as  applied  to  these  cases  has  been  stated  by 
Lord  Hale :  "  It  is  sufficient  to  prove  that  the  death  of  a  person 
was  accelerated  by  the  malicious  acts  of  the  person,  although 
the  former  labored  under  a  mental  disease  at  the  time  of  the 
act.  The  intent  of  the  accused  may  often  be  judged  by  the 
character  of  the  wound  and  the  means  of  its  infliction.  Drunk- 
enness of  the  victim  admits  of  no  excuse  when  his  assailant  is 
aware,  or  ought  to  have  been  aware,  of  the  condition  of  his 
victim.  It  is  held  that  the  assailant  ought  to  have  known  that 
violence  of  any  kind  to  such  a  person  is  likely  to  be  attended  by 
dangerous  results.  It  is  known  also  that  a  wound  which  accel- 
erates death  causes  death."  The  commissioners  who  were  ap- 
pointed to  define  criminal  law  on  the  subject  of  homicide  have 
thus  expressed  themselves :  "  Art.  3.  It  is  homicide  although 
the  effect  of  the  injury  be  merely  to  accelerate  the  death  of  one 
laboring  under  some  previous  injury  or  infirmit}',  for  although 
if  timely  remedies  or  skilful  treatment  had  been  applied,  death 
might  have  been  prevented"  (Taylor,  p.  327). 

Death  from  Surgical  Operations  Necessitated  by- 
Gunshot  Wound. — The  modern  treatment  of  serious  or  so- 
called  penetrating  gunshot  wounds  where  the  cranium,  tho- 
racic viscera,  or  the  abdominal  viscera,  especially  the  intestines, 
have  been  perforated  one  or  more  times,  calls  for  surgical  pro- 
cedures which  are  of  severity  and  danger  in  proportion  to  the 
gravity  of  the  w^ound  which  necessitates  them,  and  w^iich,  while 
they  often  save  life,  must  necessarily  often  fail.  Indeed,  such 
operations  may  prove  fatal  upon  the  operating-table,  i.e.,  pa- 
tients may  die  before  the  conclusion  of  the  operation.  The 
question  may,  therefore,  arise  whether  the  person  who  inflicted 
the  wound  should  be  held  responsible  for  his  act,  or  whether  b}^ 


DEATH   FROM   SURGICAL  OPERATIONS.  625 

the  intervention  of  the  surgeon  the  responsibility  may  not  at 
least  be  shifted  from  the  shoulders  of  the  accused.  The  law  in 
this  respect  is  explicit  and  regards  such  operation  as  the  out- 
come of  necessity  and  a  legitimate  part  of  treatment,  so  that  if 
it  be  undertaken  in  good  faith,  with  reasonable  care  and  skill, 
the  accused  will  be  held  responsible,  be  the  result  what  it  may. 
The  question  of  necessity  and  the  plan  of  operation  are  left  to 
the  judgment  of  the  surgeon  in  charge.  Considering  the  re- 
sponsibility involved  in  such  cases  and  the  possibility  of  a  suit 
being  raised,  we  should  always  advise  the  operator  to  secure 
the  counsel  c2  other  surgeons  or  practitioners  in  his  vicinity. 
The  verdict  of  such  a  counsel  of  talent  will  always  stand.  Ac- 
cording to  Lord  Hale,  when  death  takes  place  from  an  unskil- 
ful operation  under  such  circumstances,  and  not  from  the 
wound,  the  responsibility  of  the  prisoner  naturally  ceases,  but 
the  burden  of  proof  that  such  has  been  unskilfully  performed 
rests  naturally  with  the  defence.  It  is  much  better  also  in 
these  cases  that  the  primary  responsibility  be  borne  by  one  sur- 
geon from  the  beginning  of  the  case,  though  he  may  associate 
with  himself  as  many  others  as  he  chooses,  since  the  ends  of 
justice  have  more  than  once  been  defeated  by  a  division  of  such 
responsibilities.  Should  it  be  made  to  appear  that  the  surgeon 
in  charge  has  not  availed  himself  of  such  means  as  are  supposed 
to  be  in  the  hands  of  exerj  competent  practitioner  and  has 
neglected  ordinary  antiseptic  precautions,  it  would  not  be  diffi- 
cult to  show  that  the  operation  had  been  unskilfully  performed, 
and  the  prisoner  would  naturally  get  the  benefit  of  such  defence. 
At  the  present  date  of  writing  there  exists  a  large  class  of  the 
profession  who  still  continue  to  do  surgery  according  to  the 
views  and  practices  of  twenty  or  thirty  years  ago,  and  who, 
while  perhaps  carrying  out  some  of  the  forms  of  antiseptic 
surgerj^,  are  still  ignorant  of  its  fundamental  principles  and 
consequently  guilty  of  neglect,  since  there  is  now  no  reason 
why  all  should  not  practise  them.  The  writer  holds  to  the  view 
that  if  it  can  be  shown  that  these  precautions  were  not  adopted 
when  others  would  have  adopted  them,  it  constitutes  criminal 
neglect. 

On  the  other  hand,  circumstances  maj^  arise  where  a  simple 
or  a  more  serious  operation  would  have  saved  life,  as,  for  in- 
stance, in   cases  of  hemorrhage,  and   where   a  surgeon   from 
40 


626  GUNSHOT   WOUNDS — PARK. 

timidit}^  or  carelessness  has  failed  to  take  the  necessary  steps. 
Such  neglect  as  this  should  inure  to  the  benefit  of  the  accused, 
but  when  at  any  time  it  can  be  shown  that  the  possible  benefits 
of  operation  have  been  offered  to  the  deceased  before  his  death 
and  have  been  declined,  the  surgeon  at  least  is  relieved  of  all 
further  responsibility.  Among  the  dangers  of  operations  under 
these  circumstances  are  of  course  to  be  reckoned  those  pertain- 
ing to  the  use  of  anaesthetics.  The  surgeon  in  charge,  however, 
is  responsible  for  the  selection  of  his  assistants,  at  least  when 
assistants  are  at  hand,  and  must  be  regarded  as  equally  com- 
petent in  this  as  in  other  features  of  the  operation ;  and  even 
though  the  patient  die  from  collapse  or  the  antesthetic,  the  bur- 
den of  proof  must  rest  with  the  defence  to  show  that  it  had 
been  unskilfully  administered. 

Note. — The  assistance  which  the  microscope  may  afford  in 
the  procurement  of  evidence  in  cases  of  gunshot  wound  is 
beautifully  illustrated  in  the  expert  testimony  reported  by  Dr. 
James,  of  St.  Louis,  in  the  presidential  address  before  the 
American  Society  of  Microscopists,  in  Washington,  August, 
1891,  printed  in  Vol.  XIII.  of  its  Transactions.  It  occurred  in 
St.  Louis,  in  the  case  of  The  People  v.  Vail,  who  had  a  pistol  in 
his  pocket  at  the  instant  when  his  wife  fell  from  a  wagon 
against  him,  knocking  him,  as  he  claimed,  against  the  wheel  of 
the  wagon,  the  pistol  being  discharged  by  accident.  By  a  mi- 
nute study  of  the  fibres  of  the  various  textures  making  up  his 
overcoat  and  of  the  effect  of  the  explosion  of  powder  upon  textile 
fabrics  almost  in  contact  with  it,  he  was  enabled  to  establish 
the  accident  and  secure  the  acquittal  of  the  accused. 


DEATH 

BY  HEAT  AND  COLD, 


INCLUDING 


INSOLATION  IN  ITS  MEDICO-LEGAL  ASPECTS. 


BY 

ENOCH  V.  STODDARD,  A.M.,  M.D., 

Emeritus  Professor  of  Materia  Medica  and  Hygiene  in  the  University  of  Buffalo; 

Member  of  the  Medical  Society  of  the  State  of  New  York  and  of  the  Central 

New  York  Medical  Association;   Fellow  of  the  New  York  Academy 

of  Medicine  and  of  the  American  Academy  of  Medicine; 

Late  Surgeon  65th  Regt.  N.    Y.    Vols, ;  Late 

Health  Commissioner,  Rochester, 

N.  Y. ;  etc. ,  etc. 


DEATH  BY  HEAT  ANJ)  COLD. 

TEMPERATURE   OF   THE  BODY. 

The  production  and  regulation  of  heat  in  the  body  is  a 
problem  by  no  means  elucidated.  We  consider  heat  production 
to  be  of  internal  origin,  by  a  complex  process  involving  tissue 
metamorphosis,  chemical  changes  in  nutrient  elements,  mus- 
cular movements,  etc.  Heat  regulation  is  accomplished,  not 
only  by  variation  in  the  loss  of  heat  by  the  body,  but  by  what 
is  more  important,  variations  in  the  amount  of  heat  generated. 
It  is  an  accepted  physiological  conclusion  that  there  exists  in 
the  body  a  thermotaxic  nervous  mechanism  which  controls  its 
normal,  as  well  as  its  abnormal,  manifestations  of  heat. 

The  average  temperature  of  the  body  in  health  is  37°  C. 
(98.6°  F.),  in  the  axilla.  Taken  in  the  vagina  or  rectum,  .9°  C. 
(1.3°  F.)  higher  is  noted.  The  daily  average  range  of  varia- 
tion is  about  1°  C.  (1.8°  F.). 

In  disease  or  injury  considerable  variations  occur;  very 
high,  as  well  as  very  low,  temperatures  are  met.  In  severe 
neuroses  and  some  forms  of  malarial  disease  a  temperature  of 
42.2°  C.  (115°  F.)  has  been  recorded,  and  after  an  injury  71° 
C.  (122°  F.).' 

Very  low  temperatures  are  reported  in  several  cases  of  acute 
alcoholism,  accompanied  by  exposure  to  cold,  where  a  tempera- 
ture of  28.8°  C.  (75°  F.)  in  the  rectum  was  noted,  recovery 
following.  * 

Such  extreme  temperatures,  though  authentic,  are  excep- 
tional. 

Very  high  temperatures  in  febrile  conditions  are  borne  be- 
cause remitting;  and  low  temperatures,  subject  to  periods  of 
elevation,  are  met  in  wasting  and  other  conditions.  Very 
high  and  very  low  temperatures  are   also   noted,  just  before 

'Reported   by  Teale,   Lon.    Clin.  '^Reineke.    Brit,    and    For.    Med. 

Society,  Feb.  26tli,  1875.  and  Surg.  Rev.,  April,  1876. 


(330  HEAT    AND    COLD — STODDARD. 

death,  in  acute  diseases  and  conditions  specially  involving  the 
nervous  system. 

The  degree  to  which  the  temperature  may  be  raised  without 
destroying  life  has  been  investigated  by  Berger,  Bernard, 
Chossat,  and  others.' 

Their  experiments  show  that  if  an  elevation  of  temperature 
of  the  body  7.20°  C.  (13°  F.)  be  maintained  for  any  length  of 
time  in  warm-blooded  animals,  death  ensues.  Depression  of 
the  temperature  of  warm-blooded  animals  12°  C.  (20°  F.),  or 
even  less  than  these  degrees  below  the  normal,  results  fatally. 
Portions  of  the  bod}"  may  be  frozen  and  yet,  under  appropriate 
treatment,  recover.  But  freezing  of  the  whole  body  must  nec- 
essarily prove  fatal. 

Great  differences  in  ability  to  endure  extremes  of  heat  and 
cold  appear  among  different  nations  and  in  different  individ- 
uals. The  very  young  and  the  very  old  are  unable  to  bear  ex- 
posure to  extreme  cold.  In  both,  the  capacity  for  heat  produc- 
tion is  low  and  the  vital  powers  are  soon  enfeebled  to  a  critical 
degree.  The  healthy  adult  can,  with  proper  precautions,  safely 
endure  great  extremes  of  heat  and  cold.  The  experience  of 
arctic  explorers  in  the  expeditions  of  Kane,  Nares,  Greely,  and 
others  has  demonstrated  the  power  of  endurance,  for  a  consid- 
erable period,  of  a  temperature  from  00°  to  100°  F.  below  the 
freezing-point.  On  the  other  hand,  laborers  employed  in  pottery 
and  other  establishments,  using  ovens  raised  to  148°  to  315°  C. 
(300°  to  600°  F.)  or  higher,  are  often  exposed  for  some  time 
without  injury  to  temperatures  approaching  these  intense 
figures. 

EFFECTS  OF  EXTREME  COLD. 

Legal  inquiry  into  the  conditions  of  death  from  cold  occurs 
almost  entirely  in  cases  of  unintentional  exposure.  Cold  has 
been  employed,  however,  with  homicidal  intent.  The  depress- 
ing influence  of  continued  low  temperatures  is  observed  in  the 
death-rates  of  cities,  in  winters  of  protracted  severity,  where 
the  proportionate  mortality  among  infants,  the  aged  and  en- 
feebled shows  marked  increase.  While  age  is  a  prominent 
predisposing  and  contributing  factor,  other  causes  exist.     Ex- 

'  "Experiences  sur  les  effets  de  chaleur,  etc.,"  Jour,  de Physique,  Ixiii., 
p.  77.     Paris,  1805. 


EFFECTS    OF   EXTREME   COLD.  631 

haustion  from  severe  and  prolonged  exertion,  deprivation  of 
food,  intoxication,  former  illness,  and  other  conditions  of  depres- 
sion lessen  the  powers  of  the  body  to  resist  cold.  Thus  an 
exposure  which  might  be  safely  borne  in  perfect  health  might 
result  fatally  in  the  same  person  in  conditions  of  depression 
just  referred  to  (Case  1). 

Investigation  may  be  demanded  in  case  of  the  death  of 

A.  Young  children. 

B.  The  injured. 
C  The  insane. 

A.  In  Young  Children.— This  may  be  in  the  new-born 
or  older  children. 

In  the  new-horn  exposure  to  cold  soon  causes  death,  as 
warmth  is  essential  to  the  life  of  the  young  being.  The  length 
of  time  necessary  to  a  fatal  issue  is  modified  b}'  several  condi- 
tions. In  the  immature  or  prematurely  born  infant  the  resist- 
ing power  is  much  less  than  in  the  child  born  at  full  term  and 
otherwise  healthy.  In  cases  of  suspected  infanticide  by  ex- 
posure the  question  of  the  maturity  of  the  child  at  birth  is  to 
be  decided.  Careful  examination  of  the  place  in  which  the 
body  was  discovered  should  be  made  as  to  its  lack  of  warmth ; 
and  the  degree  of  external  cold  at  the  time  of  probable  ex- 
posure should  be  recorded.  The  circumstances  as  to  whether 
the  exposure  was  inadvertent  or  accidental,  as  in  cases  of  pre- 
mature or  unexpected  delivery,  or  whether  from  intentional 
and  deliberate  purpose  or  from  culpable  neglect,  should  be  care- 
fully considered.  The  post-mortem  examination  should  decide 
whether  the  appearances  and  conditions  of  the  body  are  those 
peculiar  to  death  from  cold  (Case  2). 

Death  ma}^  occur  from  culpably  careless  exposure  to  cold, 
as  a  contributory  if  not  as  a  direct  cause,  in  such  conditions  of 
enfeeblement.  Criminal  neglect  to  provide  medical  attendance, 
food,  and  other  essentials  has  been  proven  in  some  cases  of  the 
so-called  "faith  cure"  or  "prayer  cure."  Exposure  may  be 
resorted  to  with  deliberate  homicidal  intent.  It  ma}',  in  some 
cases  of  death,  become  an  important  legal  question  to  decide 
whether  a  studied  and  persistent  neglect  of  this  nature  may 
not  have  been  followed,  with  the  purpose  of  getting  rid  of  a 
troublesome  care  (Cases  2  and  13). 

B.  Exposure  of  the  injured  or  -wounded,  thereby  in- 


632  HEAT  AND  COLD — STODDARD. 

ducing  some  grave  condition  or  complication  which  under 
proper  care  would  have  been  avoided,  may  raise  an  important 
question  in  injuries  inflicted  by  another,  with  or  without  crimi- 
nal intent.  It  is  undeniable  that  serious  or  fatal  results  may 
follow  a  slight  wound,  otherwise  trivial,  where  the  injured  person 
was  subjected,  accidentally  or  intentionally,  to  extreme  cold  for 
a  considerable  period.  "While  such  cases  are  comparatively 
rare,  they  may  demand  investigation, 

C.  Exposure  of  the  Insane. — While  it  must  be  admitted 
that  the  insane  subject  is  usually  indifferent  to  matters  of  tem- 
perature, death  from  exposure  to  cold  may  call  for  special 
examination.  Carelessness,  incompetence,  or  wilful  neglect  on 
the  part  of  nurses  or  keepers  of  insane  hospitals,  or  deliberate 
criminal  intent  in  such  or  others  having  the  care  of  or  an  in- 
terest in  the  death  of  an  insane  person  may  lead  to  a  judicial 
inquiry. 

Sudden  death  has  been  reported  as  occurring,  in  several 
cases,  after  the  ingestion  of  large  quantities  of  cold  water 
when  the  person  was  greatly  heated.  It  is  somewhat  difficult 
to  explain  all  such  cases  reported  on  a  single  line  of  causation. 
Some  observers  have  attributed  death  to  syncope  or  asthenia  by 
the  shock  produced,  in  the  sudden  effect  of  the  cold  upon  the 
sympathetic  nervous  system  inducing  heart  failure.  This 
seems  the  most  natural  explanation. 

Others  consider  the  causative  factor  to  be  the  formation  of 
thromboses  in  the  capillaries  of  the  brain,  lungs,  and  other 
organs,  inducing  active  and  obstructive  congestions  causing 
death  by  apnoea  or  coma.  Others  regard  these  cases  as  similar 
to  "heat  apoplexy." 

Symptoms. 

Under  the  influence  of  external  cold,  the  vessels  of  the  skin 
are  contracted  and  the  internal  splanchnic  areas  dilated.  Thus 
the  surface  of  the  body  contains  less  blood  and  the  internal 
organs  a  larger  proportion.  This  vascular  change  is  one  of  the 
important  factors  in  maintaining  the  uniform  temperature  of 
the  body.  The  thermometer,  placed  in  the  mouth,  in  such  con- 
ditions frequentl}'  indicates  a  rise  of  temperature.  This  is 
probably  due,  not  only  to  the  increased  volume  of  blood  collected 


TREATMENT.  033 

in  the  internal  organs,  but  also  to  an  increased  production  of 
heat  through  a  thermogenic  action. 

In  exposure  for  a  time  to  severe  cold  the  nose,  ears,  cheeks, 
hands,  feet,  and  other  portions  of  the  body,  after  the  first  ap- 
pearance of  dusky  lividity,  become  bloodless  and  white,  lose 
sensation,  and  become  congealed ;  a  condition  known  as  "  frost- 
bite." From  this,  recovery  without  injury  is  possible  under 
appropriate  treatment,  by  which  the  temperature  is  gradually 
raised  and  the  circulation  restored.  Where  the  latter  result  is 
not  secured,  the  part  becomes  gangrenous  and  is  ultimately  re- 
moved by  a  process  of  inflammation  and  sloughing. 

If  the  application  of  cold  be  protracted  and  the  temperature 
extreme,  the  loss  of  heat  becomes  rapid  and  symptoms  of  de- 
pression of  the  heart's  action  appear.  Painful  sensations  of  the 
surf  ace  and  other  portions  of  the  body  are  experienced,  succeeded 
by  impaired  sensation  and  ansesthesia.  The  skin  acquires  a 
dusk}',  reddish,  and  livid  appearance,  with  the  formation  oc- 
casionally of  vesicles  or  blisters.  With  the  lessened  sensation 
stiffness  of  the  limbs  appears,  due  to  failing  muscular  contrac- 
tility. The  congestion  of  the  central  portions  of  the  nervous 
system  induces  a  condition  of  advancing  stupor,  resulting  in 
complete  coma  with  ultimate  suspension  of  respiration  and  the 
heart's  action. 

Death  from  exposure  to  cold  maj'  be  rapid  or  slow.  In  cases 
of  recovery  the  period  of  reaction  is  a  critical  one.  The  de- 
pression of  the  heart  is  apt  to  continue,  and  gangrene  of  parts 
of  the  body  is  likely  to  occur.  Ulcers  and  sores  healing  with 
difficulty  develop  in  some  cases. 

Treatment. 

In  the  treatment  of  those  who  are  suffering  from  the  effects 
of  extreme  cold,  the  restoration  of  the  congealed  or  "  frost-bit- 
ten" portions  of  the  body  should  be  gradually  accomplished. 
Raising  the  temperature  rapidly  is  liable  to  induce  the  death 
and  destruction  of  the  affected  parts.  Ice  or  snow  should,  at 
first,  be  rubbed  upon  the  frozen  part,  to  be  succeeded  later  by 
cold  water.  The  patient  should  be  placed  in  a  cool  room  and 
distant  from  the  fire  or  source  of  heat.  As  soon  as  warmth 
begins  to  return  the  part  should  be  enveloped  in  wool,  cotton. 


634  HEAT   AND    COLD — STODDARD. 

or  some  substance  of  poor  conducting  powers.  If  the  whole 
body  be  chilled,  frictions  of  the  surface  with  stimulating  lotions 
are  of  benefit,  wrapping  the  person  in  woollen  or  fur  coverings 
or  garments  afterward. 

Hot  coffee  or  alcoholic  stimulants  are  of  value  as  restora- 
tives, but  the  latter  are  to  be  avoided  during  an  exposure  to 
cold. 

PosT-MoRTEM  Appearances. 

The  appearances  indicative  of  death  from  cold  are  suffi- 
ciently marked  to  enable  one  to  decide  whether  exposure  to  cold 
was  the  chief  determining  cause  of  death,  provided  that  a  care- 
ful consideration  of  the  circumstances  of  season,  temperature, 
place,  and  other  conditions  be  also  had. 

In  the  examination  of  a  body  in  a  case  of  apparent  death 
from  cold,  the  limbs  and  internal  organs  may  be  found  frozen. 
It  must  be  remembered  that  this  occurs  after,  not  before,  death ; 
and  the  frozen  condition  must  not  be  mistaken  for  "rigor 
mortis. " 

In  cases  where  a  body  is  found,  in  freezing  conditions  of 
atmosphere,  showing  commencing  putrefaction,  the  death  must 
not  be  hastily  attributed  to  cold,  which  prevents  putrefaction. 
It  is  evident  that  if  cold  was  the  cause  of  death  the  tempera- 
ture of  the  body  had  been  raised  since  that  event,  or,  more  prob- 
ably, death  occurred  from  other  causes  and  the  body  remained 
some  time  before  becoming  frozen. 

The  finding  of  a  body  in  the  snow  or  frozen  in  severe 
weather  must  not  preclude  the  search  for  other  causes  of  death, 
such  as  apoplexy,  etc.,  which  may  have  occurred  anterior  to  the 
freezing. 

Observers  generally  have  agreed  upon  the  presence  of  cer- 
tain post-mortem  conditions  in  cases  of  death  from  cold. 

Externally. — Upon  the  skin  are  found  dusky  reddish 
patches,  irregular  in  outline,  which  are  in  sharp  contrast  with 
the  general  pallor  of  the  surface.  Krajewskey,'  Ogston,°  Die- 
berg,^  and  others,  in  the  several  series  of  cases  reported  by  them, 
all  describe  this  condition.     The  skin  otherwise  is  pale. 

'  Henke's  "  Zeitschrift, "  1860.  ■' Caspar's      "  Vierteljahrsclirift, " 

■'  Brit,  and  For.  Med.  -Chir.  Rev. ,       1864. 
1855. 


EFFECTS   OF   EXTREME    HEAT.  (335 

Internally. — The  viscera,  including  the  brain,  are  con- 
gested. The  heart  contains  a  large  quantity  of  blood  in  the 
cavities  of  both  sides,  and  the  large  vessels  leading  from  it  are 
also  full.  The  color  of  the  blood  is  a  bright  red,  resembling  its 
arterial  hue.  This  condition  has  been  generally  noted  and  de- 
scribed ;  but  some  excellent  observers  have  not  referred  to  it. 

EFFECTS   OF  EXTREME   HEAT. 

The  application  of  moderate  heat  to  the  surface  of  the  body 
causes  dilatation  of  the  cutaneous  capillaries.  In  such  applica- 
tion the  exhalant  and  perspiratory  function  of  the  skin  is  in- 
creased, by  which  means  a  rise  in  general  body  temperature  is 
prevented.  If,  however,  severe  physical  exertion  accompany 
the  exposure,  a  more  pronounced  result  is  induced  and  a  de- 
pressing effect  upon  the  nervous  system  becomes  manifest.  If 
the  degree  of  heat  be  raised  and  the  exertion  increased  and 
prolonged,  marked  depression  ensues.  Under  circumstances 
of  quiet  and  rest  a  high  degree  of  temperature  is  borne  by  man 
without  depression  or  discomfort,  but  with  continued  and  severe 
muscular  effort  the  rise  in  animal  temperature  is  productive  of 
distress  and  depressing  conditions.  In  the  Turkish  or  Russian 
baths,  in  the  healthy  subject,  a  temperature  of  48.8°  to  54.4°  C. 
(120°  to  130°  F.)  produces  profuse  perspiration  but  no  depres- 
sion, and  a  plunge  in  or  affusion  of  cold  water  is  not  only 
borne  with  impunity  but  is  acceptable.  In  conditions  of  heat 
accompanied  by  phj^sical  exhaustion,  such  sudden  exposure  to 
cold  would  prove  extremely  dangerous. 

In  the  condition  of  rest,  exposed  to  external  heat,  the  ten- 
dency to  elevation  of  body  temperature  arises  from  the  external 
causes  alone,  which  in  no  way  specially  modify  the  nutritive 
functions.  But  in  the  second  condition  the  internal  processes 
of  nutrition,  which  have  been  subject  to  great  stimulation,  are 
suddenly  embarrassed  by  suppression  of  the  compensating 
activity  of  the  cutaneous  surface,  and  severe  organic  and  ner- 
vous derangements  follow. 

In  the  summer  season  the  temperature  rises  to  32.3°  C 
(90°  F.)  and  even  much  higher  in  certain  localities.  During 
the  prevalence  of  such  heat,  tlie  mortality  among  young  chil- 
dren, the  aged  and  enfeebled  is  ver}-  marked ;  these  two  periods 


636        V     HEAT  AND  COLD — STODDARD. 

of  life  being  very  susceptible  to  the  depressing  effects  of  heat. 
A  high  temperature  is  easily  borne  if  the  air  be  pure  and  the 
atmosphere  be  not  saturated  with  moisture.  Telluric  electric 
conditions  also  have  a  modifying  influence,  undoubted  though 
obscure. 

In  certain  occupations  an  intensely  heated  atmosphere  is 
endured  with  impunity  for  a  considerable  time,  provided  the 
air  be  maintained  in  a  condition  of  purity  and  water  be  sup- 
plied to  the  person  exposed.  The  stokers  upon  ocean  steam- 
ships, where  a  forced  draught  is  employed,  are  subjected  to  ex- 
treme heat,  sometimes  reaching  60°  C.  (140°  F.).  Resort  to 
forced  and  continuous  ventilation  of  the  stoke-roums,  with  short 
hours  of  duty,  renders  tolerance  of  the  high  temperatures 
possible. 

SUNSTROKE. 

The  terms  "sunstroke,'^  "insolation,"  "coup  de  soleil," 
are  applied  to  conditions  induced,  not  alone  by  exposure  to  the 
rays  of  the  sun,  but  rather  by  a  combination  of  great  heat  with 
other  exciting  causes.  They  are  used  to  designate  attacks  oc- 
curring in  very  hot  weather  after  exposure  to  solar  or  other 
sources  of  extreme  heat.  The  striking  and  usual  phenomena 
are  exhaustion,  unconsciousness,  stertorous  respiration,  and 
death,  occurring  by  syncope,  within  a  few  moments  or  hours. 
In  a  number  of  cases  the  symptoms  of  cerebral  apoplexy  with 
death  by  coma  are  present. 

In  others,  the  condition  seems  one  of  complete  exhaustion. 
The  majority  of  cases  seem  to  be  a  combination  of  these  several 
conditions,  with  death  resulting  from  syncope. 

The  ordinary  phenomena  of  the  attack  are  pain  in  the  head, 
hurried  respiration  sometimes  stertorous,  violent  beating  of  the 
heart  with  failing  of  its  power,  oppression  within  the  chest  and, 
occasionally,  nausea  and  vomiting.  The  pupils  are  sometimes 
dilated  and  sometimes  contracted,  but  in  all  cases  exhibit  less- 
ened sensitiveness  to  light.  The  suddenness  of  the  attack  mod- 
ifies the  symptoms  developed. 

Pathological  Conditions. 

These  are  exhaustion  with  syncopic  tendency  and  a  rapid 
rise  in  the  temperature  of  the  body  to  a  point  destructive  to 


TREATMENT.  637 

the  activity  of  the  nervous  centres.  This  is  accompanied  by 
an  abnormal  condition  of  the  blood,  resulting  from  loss  of  its 
watery  portions,  with  retention  of  effete  products  and  impaired 
aeration.  A  tendency  to  general  stasis,  specially  marked  by 
congestions  of  the  lungs  and  brain,  is  present.  The  change  in 
the  blood  is  a  very  important  factor.  In  some  cases,  not  fatal 
at  the  outset,  this  induces  a  septic  condition. 

The  greatly  elevated  temperature  of  the  body  undoubtedly 
produces  certain  modifications  which  type  it,  in  some  respects, 
as  a  febrile  disease;  but  this,  with  the  septic  tendency  due  to 
blood  changes,  is  not  sufficient  to  designate  it  as  a  purely 
"  thermal  fever^"  as  some  have  claimed.  It  is  something 
more  than  this. 

Sunstroke  occurs  more  commonly  in  tropical  than  temperate 
climates ; '  and  usually  in  the  day-time,  at  the  period  of  greatest 
solar  activity,  those  attacked  being  engaged  in  labor  involving 
considerable  exertion.  It  occasionally,  though  rarely,  occurs  at 
night.  The  military  service  affords  abundant  opportunity'  for 
observation.  Here  the  seizures  are  on  the  march,  rarely  in 
camp.  Fatigue,  prolonged  and  extreme  exertion,  ill-adjusted 
clothing  and  accoutrements,  with  the  deprivation  of  cool  water, 
are  fully  as  active  factors  as  the  heat  of  the  sun.  The  death- 
rate  ranges  between  forty  and  fifty  per  cent,  the  mild  cases 
being  excluded.  Death  in  some  cases  is  marked  by  syncope, 
in  others  by  apnoea,  though  the  majoritj''  seem  to  die  by  a  com- 
bination of  both,  as  in  most  cases  the  pulmonarj"  congestion  is 
more  or  less  pronounced.  Undoubtedly  the  character  of  the 
symptoms  and  mode  of  death  are  influenced,  in  many  cases,  by 
individual  tendencies  leading  to  apoplectic  conditions  or  to  car- 
diac or  other  complications. 

Treatment. 

This  must  be  adjusted  to  the  pathological  conditions  of  the 
patient.  As  already  indicated,  two  classes  of  cases  are  met: 
one  marked  by  exhaustion,  with  tendency  to  death  by  syncope", 
the  other,  a  state  of  or  tendency  to  cerebral  congestion  or  apo- 
plectic conditions.     Exactly  opposite  methods  of  treatment  are 

'Fliut,  " Practice  of  Medicine, "  p.  685;  Aitken,  "Practice  of  Med- 
icine," vol.  ii.,  p.  388. 


638  HEAT    AND    COLD — STODDARD. 

demanded.  In  the  first,  frequenc}'  and  feebleness  of  the  heart's 
action,  with  faintness  of  the  heart  sounds  and  embarrassment 
of  respiration,  indicate  the  tendency  to  death  by  nervous  ex- 
haustion, and  must  be  met  by  placing  the  patient  in  a  condition 
of  absolute  rest  and  quiet  in  a  cool  place.  Stimulants  must  be 
promptly  administered,  though  cautiously  on  account  of  the 
tendency  to  nausea  and  vomiting.  Hypodermic  injections  of 
alcohol  or  ether,  or  rectal  enemata  of  turpentine,  alcohol,  or 
other  stimulants,  afford  means  of  securing  speedy  effects  when 
the  stomach  is  irritable.  Carbonate  of  ammonia  and  other 
cardiac  stimulants  are  recommended.  Depleting  agents,  or 
such  as  prove  depressing,  are  to  be  avoided.  In  some  cases, 
hypodermic  injections  of  small  doses  of  morphine  prove  bene- 
ficial.    Individual  cases  must  modify  therapeutic  procedures. 

In  the  second  class  of  cases  the  tendency  to  cerebral  conges- 
tion indicates  sedative  and  depleting  procedures.  Blood-letting 
has  been  recommended  by  some  authors,  if  employed  with  ex- 
treme judgment  and  discrimination.'  Cold  applied  to  the  head 
and  also  to  the  whole  body  by  rubbing  with  ice  '^  or  by  effusion 
and  the  wet  sheet,  or  other  means,  is  indicated  if  the  tempera- 
ture is  high  (104:°  to  105°  F.).  Active  catharsis,  by  promptly 
acting  purgative  enemata,  is  also  to  be  resorted  to  in  most 
cases.  The  convulsions  occurring  in  some  cases  are  success- 
fully modified  and  controlled  by  inhalations  of  small  quantities 
of  chloroform. 

PosT-MoRTEM  Appearances. 

These,  though  not  clearly  characteristic,  are  pronounced. 
In  some  cases  no  distinct  conditions  are  found. ^  Local  conges- 
tions are  present  in  nearly  all  cases.  Upon  the  skin  are  found 
petechial  and  livid  spots,  pallor  being  occasionally  noted.  Ec- 
chymoses  and  subserous  hemorrhages  are  also  common.  These 
conditions  have  been  described  as  resembling  those  of  spotted 
typhus  (Levick). 

Rigor  mortis  is  marked  and  occurs  early,  putrefaction  be- 
ginning soon  after  death.     The  lungs  are  highly  congested  and 

'Flint,  "Practice   of  Medicine,"  -Levick,      Amer.      Jour.      Med. 

p.  685  ;  Aitken,   "  Practice  of  Med-       Sciences,  Oct. ,  1866. 
icine, "vol.  ii.,  p.  391.  ^Katzenbach,    New    York    Med. 

Jour.,  vol.  xvii.,  p.  91. 


BURNS    AND    SCALDS.  G39 

often  oedematous,  and  effusions  of  serum  are  frequently  found 
in  the  pleural  cavities/ 

The  heart  is  usually  changed  in  color  and  consistence,  with 
the  left  ventricle  contracted  and  the  aorta  empt}',  while  the 
right  ventricle  and  pulmonary  arteries  are  dilated  and  engorged. 
The  blood  is  fluid  and  dark."  The  large  vessels  of  the  pia  and 
dura  are  full  of  dark  blood.  Congestion  of  the  cerebral  mass 
is  not  always  noted.  The  ventricles  contain  serum;  and  ex- 
travasations of  blood  into  the  cervical  sympathetic  ganglia  and 
vagus  are  sometimes  found.  The  kidneys  are  usually  moist 
and  oedematous ;  the  liver  and  spleen  congested  and  dry. 

BURNS   AND   SCALDS. 

For  all  purposes  of  practice  it  is  unnecessary  to  draw  any 
distinction  between  a  burn  and  a  scald,  for  in  reality  none  ex- 
ists, except  as  regards  the  nature  of  the  causative  agent.  In 
some  cases  requiring  investigation,  this  may  prove  to  be  a  mat- 
ter of  much  importance. 

Definition. — A  burn  is  an  injury  produced  by  the  apjolica- 
tion  to  the  body  of  a  heated  substance,  flame  or  radiant  heat. 

A  scald  is  an  injury  produced  by  the  application  of  a 
liquid  at  or  near  its  boiling-point. 

Appearances  as  Indicating  Origin. 

A  hot  body  maj-  produce  a  burn  of  any  intensity,  ranging 
between  reddening  of  the  skin  and  complete  charring  of  the 
tissues,  according  as  its  temperature  is  elevated  and  the  period 
of  contact  prolonged :  the  shape  of  the  object  and  its  size  being 
indicated  by  the  form  of  the  burn.  Metallic  substances  heated 
to  a  temperature  of  100°  C.  (212°  F.)  are  capable  of  producing 
redness  and  vesication  and  other  injurious  effects.  At  this 
temperature  the  albuminous  elements  of  the  blood  and  other 
fluids  undergo  coagulation.  Some  bodies  require  to  be  heated 
to  redness,  or  nearly  so,  in  order  to  produce  a  defined  burn. 

Very  hot  and  partiallj^-fused  solids  cause  burns  of  greater 
severity  than  where  the  heated  body  is  of  a  character  favoring 

'  Wood,  Phil.  Med.  Times,  Aug.  ■  Hanfield     Jones,     Brit.       Med. 

5th,  1876.  Jour.,  July,  1870,  p.  35. 


640  HEAT  AND  COLD — STODDARD, 

prompt  removal.  In  such  cases  their  adhesion  to  the  skin  in- 
volves the  tearing  away  of  the  superficial  portions  of  the  derma 
in  their  removal,  or  they  by  their  adherence  prolong  the  con- 
tact of  the  heated  body,  thus  intensifying  their  destructive 
action. 

Metals  in  a  state  of  fusion  produce  burns  which  can- 
not be  easily  distinguished  from  those  caused  by  solid  bodies. 
Such  burns  are  classed  as  scalds.  Their  effects  may  vary  in 
any  degree  between  slight  redness  and  complete  destruction  of 
the  tissues  with  charring.  Burns  caused  by  melted  solids  are 
less  regular  in  form  and  outline  than  those  caused  by  heated 
solids.  They  are  usually  of  greater  severity  on  account  of  the 
high  temperature  to  which  they  have  been  raised.' 

Boiling  Water. — Scalds  by  boiling  water  maybe  so  slight 
as  to  produce  redness  only,  or  they  may  be  so  severe  as  to  cause 
marked  and  characteristic  symptoms.  Those  noted  in  severe 
cases  are  an  ashy  hue  of  the  skin,  accompanied  by  a  soaked  or 
sodden  appearance  and  the  production  of  blisters.  Occasion- 
ally these  features  are  not  easily  distinguished  from  those  of 
burns  from  other  sources.  Blackening  of  the  skin  and  charring 
of  the  tissues  never  result  from  burns  by  boiling  water.  As  in 
all  burns,  a  large  surface  involved  renders  an  early  fatal  issue 
probable.  In  severe  cases,  not  necessarily  fatal,  gangrene  of 
the  parts  injured  sometimes  occurs.  Most  of  those  met  with 
are  accidental,  yet  cases  of  scalding  by  hot  water  with  intent 
to  injure  are  not  uncommon,  aside  from  injuries  and  death 
resulting  from  explosion  of  boilers,  bursting  of  steam-pipes,  etc. 
Occasional  instances  are  recorded  of  death  of  children,  the  in- 
sane or  feeble  persons  by  inadvertent  immersion  in  a  bath  of 
hot  water  (Case  21). 

Severe  and  fatal  burns  of  the  mouth,  fauces,  and  larynx  in 
j'-oung  children  occur  from  inhaling  steam  or  swallowing  boil- 
ing water  from  a  teapot  or  kettle  in  an  attempt  to  drink 
(Case  5). 

Burns  by  burning  oil  produce  effects  and  appearances 
similar  to  those  b}'  melted  metals. 

Burns  by  flame  are  specially  characterized  by  scorch- 
ing of  the  surface.  Hairs  upon  the  part  actually  burned  are 
scorched  and  usually  also  those  in  the  vicinit}^  of  the  burned 

'  Pouillet,  Comptes  Reudus,  1836,  p.  782. 


APPEARA^XES    AS    INDICATING    ORIGIN.  641 

patches.  Such  conditions  could  not  result  from  scalds  by  hot 
water,  boiling  oil,  or  from  a  hot  body  only. 

Burns  by  petroleum  or  its  derivatives  resemble  the 
burns  from  flame,  except  that  the  injured  portions  of  the  body 
are  not  only  scorched  but  blackened  and  are  usually  burned 
more  severely  than  by  flame  alone,  as  the  clothing  holds  the 
burning  substance  in  contact  with  the  parts.  The  odor  of  the 
agent  is  also  very  noticeable. 

Burns  by  Acids  and  Corrosive  Agents. — The  injury 
produced  by  a  mineral  acid,  the  caustic  alkalies,  etc.,  has  fre- 
quently been  the  source  of  judicial  inquiry.  "  Vitriol-throwing, " 
as  it  has  been  termed,  has  been  and  occasionally  is  resoited  to 
with  malicious  intent  to  injure.  No  case  of  death  resulting 
directly  and  solely  from  this  cause  is  recorded,  but  grave  in- 
juries, involving  loss  of  sight,  etc.,  have  resulted.  A  case  is 
referred  to  by  Taylor '  where  sulphuric  acid  was  poured  into 
the  ear  of  a  woman  while  asleep  by  her  husband.  Death  en- 
sued, after  six  weeks,  from  disease  of  the  brain  resulting  in- 
directly from  the  use  of  the  acid. 

The  appearances  of  a  burn  by  a  mineral  acid  are  distin- 
guished from  heat  burns  with  little  difficulty.  The  eschar 
which  results  is  not  dry  and  leather}^,  as  in  a  burn  by  heat,  but 
soft  and  readily  sloughing  away.  There  is  no  redness  around 
the  site  of  the  injury,  the  color  of  the  burn  being  uniform,  and 
no  blisters  are  formed.  There  is  no  blackening  of  the  skin  and 
the  hairs  are  not  scorched.  The  color  of  the  skin  around  the 
injured  portion  may  afford  valuable  evidence  of  the  nature  of 
the  agent  employed.  Nitric  acid  produces  a  yellow  stain,  sul- 
phuric acid  a  dark  brown,  and  chlorohydric  acid  a  brownish- 
yellow  stain.  "^  The  clothing  also  is  capable  of  affording  char- 
acteristic evidence  b}^  the  discolorations  produced;  and  the 
destructive  agent  employed  may  be  determined  by  a  chemical 
analysis  of  the  fabric.^ 

It  is  not  possible  to  distinguish  a  post-mortem  from  an  ante- 
mortem  burn  by  an  acid  when  no  vital  reaction  has  taken 
place. 

'Taylor,    "Med.    Jurisprudence,"  '^  Chainbert,  Annales  d' Hygiene. 

8th   Amer.    Ed.,   p.    444;   also    the      1859. 

Med.  Gazette,  vol.  xviii.,  p.  89.  ^Buchner,    Prager    Vierteljahr., 

i.,  p.  139. 

41 


642  HEAT   AND   COLD — STODDARD. 


THE  CLASSIFICATION   OF  BURNS. 

A  classification  of  burns  according  to  the  severity  of  the 
injury  inflicted  is  the  most  practical  course.  Upon  this  plan, 
1)arns  may  be  divided  into  four  general  classes: 

I.  Burns  in  which  the  skin  or  subcutaneous  cellular  tissues 
only  are  injured. 

II.  Burns  which  involve  the  muscles,  nerves,  and  blood- 
vessels. 

III.  Burns  involving  the  internal  organs  and  bones. 

IV.  Burns  in  which  the  other  three  classes  are  variously 
mixed. 

Class  I. — The  skin  in  cases  such  as  may  occur  from  a 
brief  contact  with  a  hot  body  or  water  near  the  boiling-point 
shows  a  slight  redness  or  scorching  with  no  enduring  mark. 
Pain  is  considerable. 

Class  II. — In  the  mildest  cases  the  cutis  is  destroyed  in  its 
whole  thickness,  and  the  parts  injured  are  occupied  by  eschars 
of  a  yellowish -gray  or  brownish  color.  The  surrounding  skin 
is  reddened,  and  the  formation  of  blisters  occurs  either  imme- 
diately or  after  an  interval  of  a  few  hours.  In  these  cases  a 
shining  cicatrix  remains  after  the  healing,  without  contraction 
of  surrounding  parts.  In  the  severer  cases  the  subcutaneous 
cellular  tissue  and  underlying  muscles  and  nerves  are  destroyed. 
The  blackish  eschars  formed  are  insensible  and  separate  by  sup- 
purative process,  leaving  a  granulating  surface  below.  Ex- 
tensive redness  of  surrounding  tissues,  with  more  or  less  vesi- 
cation, is  usuall}"  noted.  The  resulting  cicatrices,  together 
with  the  skin  and  adjoining  structures,  are  prone  to  contraction, 
resulting  in  considerable  deformity,  according  to  location  and 
extent.  So  great  is  the  deformity  in  injuries  of  the  extremities, 
or  even  some  parts  of  the  head  and  trunk,  that  extensive  sur- 
gical operations  become  necessary  to  relieve  it. 

Class  III. — Burns  of  this  class  are  so  severe  that  an  imme- 
diately fatal  issue  is  usually  the  result.  Such  instances  in- 
volve a  prolonged  exposure  to  flame  or  to  a  source  of  intense 
heat.  The  appearances  described  as  belonging  to  the  preceding 
class  are  in  part  found  here  with  the  addition  of  charring  or 
carbonizing  the  parts  destroj^ed. 


EFFECTS   OF   BURNS.  G43 


EFFECTS   OF   BURNS. 


The  effects  of  burns  may  be  considered  as  I.,  Locals  and 
II.,  Constitutional. 

Local  Effects. — In  different  instances  the  effects  vary  in 
accordance  with  the  extent  and  severity  of  the  burn.  Redness, 
bhsters,  destruction  of  the  cuticle  and  of  the  subcutaneous  cel- 
hilar  tissue,  blackening  of  the  skin,  scorching  of  the  hair,  and 
roasting  of  portions  of  the  body  are  met  with  in  varying 
degrees.  In  some  severe  cases  all  these  are  found  upon  a  sin- 
gle body.  The  redness  produced  varies  in  intensity  and  extent, 
according  to  the  nature  of  the  agent  producing  the  burn,  its 
form,  and  the  length  of  time  the  part  was  exposed. 

Very  soon  after  the  infliction  of  the  burn  a  special  lino  of 
redness  appears  between  the  burned  parts  and  the  uninjured 
skin.  This  red  line  of  demarcation  is  formed  by  intensely 
injected  vessels  and  becomes  a  very  important  medico-legal 
sign  in  some  cases.  The  vesication  may  be  single  or  multiple, 
consisting  of  one  or  two  large  and  full  blisters  or  a  number  of 
large  and  small  ones,  scattered  over  the  portions  burned,  some 
unbroken  and  still  holding  their  contents,  others  broken  and 
denuded  of  cuticle  or  with  breaks  from  which  their  serum  has 
escaped  upon  the  surrounding  parts.  In  some  cases  of  burning 
cracks  or  fissures  in  the  skin  occur,  due  to  the  effect  of  the 
heat,  making  it  dry  and  brittle  and  causing  it  to  rupture  by  the 
movements  of  the  patient  (Case  8).  These  fissures  are  most 
frequently  noted  in  proximity  to  the  joints.'  They  resemble 
wounds,  and  it  occurs  occasionally  that  it  is  important  to  accu- 
rately distinguish  their  character.  In  some  cases  the  skin  only 
is  fissured ;  in  others  the  subjacent  tissues  are  also  involved. 
This  difference  depends  upon  the  depth  of  the  burn.  In  the 
first  condition  the  skin  splits,  leaving  the  subcutaneous  fat 
exposed,  which  in  some  instances  is  partially  melted  by 
the  heat  and  flows  out  over  the  edge  of  the  crack  upon  the 
surrounding  skin  (Cases  8,  13).  The  blood-vessels  in  such 
cases  usually  are  not  burned  and,  owing  to  their  elasticity, 
remain  stretching  across  the  fissure  (Case  14).  The  smaller 
may  be  seen  by  careful  examination  with  a  lens :  they  should 
'Tidy,  "  Legal  Medicine, "  vol.  ii.,  p.  124. 


644  HEAT  AND  COLD— STODDARD. 

always  bo  looked  for.  In  the  second  class  of  injuries  the  ves- 
sels are  involved  in  the  burn  and  break  with  the  cracking  of 
the  skin.  The  importance  of  careful  observation  of  these  fis- 
sures is  emphasized  in  cases  of  apparent  wounds  associated 
with  burning.  It  may  be  necessary  to  decide  whether  the 
wounds  are  the  result  of  the  action  of  heat  as  above  described 
or  were  caused  by  some  sharp  instrument  or  weapon.  Careful 
inspection  of  the  edges  of  the  wounds  will  show  whether  they 
are  ragged,  as  the  result  of  fissure,  or  clean-cut  by  some  sharp 
instrument.  The  absence  of  evidences  indicating  hemorrhage 
upon  the  surrounding  parts  and  the  detection  of  uncut  blood- 
vessels extending  across  the  fissure  will  establish  the  differen- 
tial diagnosis.  Wounds  of  the  above  character  resulting  from 
the  action  of  fire  may  exist  on  the  same  body  with  wounds  of 
actual  violence.  It  is  important,  therefore,  in  all  cases  to  ex- 
amine each  wound  with  special  care  and  record  its  position, 
shape,  depth,  and  other  characteristics. 

Constitutional  Effects. — As  in  all  sudden  and  violent 
injuries,  the  effect  of  a  severe  burn  upon  the  nervous  system  is 
very  marked.  This  is  manifest  in  the  symptoms  of  "shock," 
with  pallor  and  coldness  of  the  surface  of  the  body,  a  feeble 
pulse,  chills  or  shivering,  and  a  tendency  to  collapse.  In  other 
cases,  proving  immediately  fatal,  these  symptoms  are  followed 
by  obstructed  respiration  with  death  from  coma  succeeding. 
In  other  cases  convulsions  precede  death,  while  in  such  as  are 
not  immediately  fatal  a  reaction  more  or  less  imperfect  ensues 
upon  the  first  constitutional  symptoms. 

Death  from  cerebral  congestion  or  effusion  may  result  be- 
fore any  definite  evidence  of  reaction  aj)pears.  In  some  in- 
stances pulmonary  congestion  or  oedema  occurs,  with  or  with- 
out pleural  effusion,  terminating  in  death  before  reaction.  This 
period  usually  covers  the  first  two  days.  In  some  cases  im- 
mediate death  results  from  the  depression  produced  bj'  the 
severity  of  the  pain.  During  the  subsequent  two  weeks  a 
period  of  inflammatory  reaction  succeeds,  when  inflammations 
of  the  thoracic  and  abdominal  viscera,  with  ulcerative  processes 
in  some  organs,  are  developed  and  induce  a  fatal  termination 
(Cases  10,  11,  16). 


causes  of  death.  (345 

Causes  of  Death. 

The  causes  of  death  are  due  to  several  conditions.  This  fact 
is  explained  in  part  by  the  relation  which  exists  between  the 
cerebro-spinal  and  sympathetic  nervous  systems,  and  of  the 
nervous  supply  of  the  surface  to  that  of  the  internal  organs, 
which  in  cases  of  extensive  injury  proportionately  modify  the 
conditions  of  the  visceral  organs.  As  death  in  burning  results 
from  various  causes,  it  is  convenient  to  consider  them  under 
two  classes : 

1st.  Those  immediately  fatal. 

2d.  Those  fatal  after  an  interval. 

The  FIRST  DIVISION  would  include  cases  in  which  the 
deprivation  of  fresh  air  and  the  presence  of  asphyxiating  pro- 
ducts of  combustion  (carbon  monoxide  and  carbon  dioxide) 
were  the  immediate  causes  of  death  by  suffocation  or  asphyxia 
(Cases  9,  18). 

Accidents  in  endeavoring  to  escape  or  injuries  by  falling 
walls  or  timbers  may  cause  death  immediately,  and  burning 
the  body  occur  subsequently. 

Immediate  death  may  result  from  syncope  or  collapse  from 
the  violence  of  the  shock  to  the  nervous  system  by  the  pain 
resulting  from  the  burns. 

The  second  DIVISION  includes  those  conditions  where  death 
may  result  early,  from  a  series  of  causes  less  immediate  than 
those  just  mentioned. 

Cerebral  congestion  and  effusion,  resulting  in  death  from 
coma,  is  not  unusual  (Case  15).  In  this  connection  Ta3'lor ' 
cites  a  case  of  alleged  poisoning  by  opium,  in  the  treatment  of 
a  burn,  in  a  child  dying  comatose,  and  emphasizes  the  unde- 
sirability  of  administering  opium  or  its  preparations  to  chil- 
dren in  cases  of  burns  of  any  severity.  The  danger  claimed  to 
exist  is  hardly  to  be  considered.  In  the  case  referred  to,  Aber- 
nethy,  who  was  a  witness  in  the  case,'  ascribed  death  to  coma 
induced  by  the  effect  of  the  burn.  The  powerfully  depressing 
influence  of  the  pain  in  sensitive  organizations  and  liability 
to  death  from  shock  therefroni  must  be  remembered. 

Inflammatory  conditions  of  the  respiratory  tract  or  organs 

'Taylor,  "Med.  Jurisprudence,"  8th  Amer.  Ed.,  p.  407. 


646  HEAT  AND  COLD — STODDARD. 

are  common  resuha ;  pneunionia,  broiichitis,  and  sudden  con- 
gestion or  oedema  of  the  lungs  are  frequent  (Cases  11,  15, 
16). 

Inflammation  of  the  intestines,  inducing  peritonitis  and 
ulcerations  of  the  intestines  with  or  without  resulting  hemor- 
rhage, occurs  as  a,  frequent  lesion  (Case  10). 

Gangrene  or  sej:)ticcemia  causes  death  in  other  instances. 

Exhaustion,  from  extensive  and  prolonged  suppuration  or 
from  severe  and  long-continued  pain  and  other  conditions,  ter- 
minates other  cases  (Case  12). 

Legally,  burns  and  scalds  are  included  among  injuries  en- 
dangering life,  but  are  not  described  as  wounds.  -They  may  bo 
considered  dangerous  according  to  the  extent  of  surface  which 
they  cover,  rather  than  the  depth  to  which  they  involve  the 
tissues. 

The  extensive  injury  to  the  sensory  nerve  structures  and  the 
suspension  of  function  or  destruction  of  a  considerable  portion 
of  the  perspiratory  tracts  render  large  superficial  burns  far  more 
fatal  than  those  confined  to  a  small  part  of  a  limb,  for  example, 
which  may  be  deeply  burned.  From  a  medico-legal  point  it 
is  desirable  to  establish  the  fact  of  how  large  a  surface  must 
be  injured  to  prove  fatal.  The  effort  to  reduce  the  subject  to 
a  statement  of  an  exact  minimum  area  of  square  inches  seems 
very  objectionable  and  liable  to  lead  to  erroneous  conclusions. 

It  is  possible  to  make  a  general  statement,  subject  to  some 
qualifications,  which  may  serve  as  a  basis  of  conclusion,  as 
each  individual  case  must  be  considered  in  its  own  circum- 
stances. 

A  burn  involving  two-thirds  of  the  body  may  be  regarded 
as  necessarily  fatal ;  but  the  injury  of  a  much  less  proportion, 
even  one-fourth  of  the  surface,  has  resulted  in  death.  The 
qualifications  to  be  made  in  burns  of  less  extent  are  pro- 
nounced. The  parf  q^ecfed  is  of  much  importance.  Burns  of 
the  trunk  are  more  fatal  than  those  of  the  extremities;  and 
those  of  the  genital  organs '  and  lower  par^j  of  the  abdomen 
are  especially  so  (Case  7). 

The  character  of  the  burn,  whether  single  and  continuous 
or  multiple  and  scattered  over  various  portions  of  the  bod}",  is 
a  very  important  modifj^ing  circumstance,  involving  the  ques- 

'Tidy,  "Legal  Medicine,"  vol.  ii.,  p.  99. 


TREATMENT — POST-MORTEM   APPEARANCES.  647 

tions  of  excessive  pain  and  the  difficulty  in  insuring  necessary 
treatment  for  all  parts  injured. 

The  physical  condition  of  the  patient  and  sensitiveness  of 
the  nervous  system  to  pain  exert  a  powerfully  determining  in- 
fluence. Burns  in  children  and  sensitive,  nervous  females  are 
specially  serious  and  call  for  an  unfavorable  prognosis. 

Spontaneous  Combustion. — Spontaneous  combustion  of 
the  human  body  has  been  seriously  discussed  in  this  connection, 
and  explanations  of  popularly  reported  cases  have  been  at- 
tempted. The  writer  refers  to  the  subject  here  for  the  sole  pur- 
pose of  stating  that  no  trustworthy  evidence  of  the  possibility 
of  any  such  condition  or  result  exists. 

j  Treatment. 

In  cases  of  severe  burns  the  constitutional  as  well  as  the 
local  conditions  demand  attention.  Locally,  a  great  variety  of 
applications  has  been  employed :  starch,  gum,  oxide  of  zinc, 
solution  of  caoutchou,  collodion,  cotton  wadding,  a  mixture  of 
linseed  oil  and  lime-water  on  cotton  or  lint,  and  many  other 
agents  are  used.  The  important  consideration  is  to  exclude 
the  air  from  and  to  afford  a  protective  covering  for  the  injured 
surface.  The  constitutional  treatment  varies  in  different  cases ; 
but  its  main  object  is  to  relieve  pain,  induce  reaction  from  the 
shock,  and  support  the  depressed  nervous  system. 

For  the  first  opium  or  its  preparations  in  proper  doses  is 
indicated.  Alcoholic  stimulants  in  some  cases  are  demnnded 
in  addition.  After  the  stage  of  reaction  has  occurred  the 
therapeutics  must  be  governed  by  inflammatory  conditions ;  or 
later  by  the  exhaustion  from  continued  pain,  suppuration,  etc. 

Post-Mortem  Appearances. 

In  the  external  post-mortem  examination  of  a  burned 
body  careful  note  should  be  made  of  the  sex,  probable  age,  and 
every  circumstance  leading  to  the  establishment  of  the  identity 
of  the  individual.  The  parts  burned  should  be  specially  exam- 
ined as  to  their  condition,  whether  exhibiting  redness,  vesica- 
tion, or  charring.  The  amount  of  surface  covered  by  the  burns 
should  be  computed ;  also  the  relation  of  the  burned  parts  to 


G48  HEAT  AND  COLD — STODDARD. 

those  uninjured,  whether  separated  by  a  sharply  marked  line  of 
redness  or  merging  into  the  sound  skin  without  a  line  of 
demarcation.  The  condition  of  the  blisters  should  be  examined 
as  to  whether  they  are  full  or  empty  and  their  contents  as  to 
whether  consisting  of  clear  or  turbid  serum. 

Internally. — In  some  cases  no  lesions  are  found  on  exam- 
ination. These  are  usually  cases  where  death  occurred  from 
shock  or  severe  pain  (Case  12).  Ordinarily  the  mucous  mem- 
brane of  the  respiratory  tracts  is  congested.  In  some  instances, 
however,  no  redness  has  been  discernible.  Where  death  oc- 
curred by  suffocation  and  asphyxia,  the  trachea  and  bronchial 
tubes  have  been  found  to  contain  a  dark  smoky  or  sooty  mucus' 
(Case  9). 

The  serous  membranes  of  the  brain,  thorax,  and  abdomen 
are  in  many  cases  found  reddened  with  effusions,  more  or  less 
considerable,  into  the  ventricles  of  the  brain  and  the  pleural, 
pericardial,  and  peritoneal  cavities  from  the  sudden  inflow  of 
blood  from  the  surface,  caused  by  the  local  injuries. 

When  the  body  has  been  badly  charred  or  incinerated  the 
skeleton  usually  remains,  and  it  is  possible  to  determine  the 
age  from  the  size  and  development  of  the  bones  and  the  sex 
from  the  shape  of  the  bones  of  the  pelvis.  Careful  search 
should  be  made  for  special  articles  of  identity.  False  teeth,"  a 
watch  and  chain,  buttons,  etc.,  have  alone  been  sufficient  to 
identify  the  incinerated  remains  (Case  23).  Where  the  whole 
body  and  even  the  bones  have  been  reduced  to  ashes,  some  por- 
tions of  bone,  etc.,  may  be  found  on  careful  search.  Sifting 
the  ashes  will  give  some  pieces  of  bone,  etc.,  which  may  be 
sufficient  to  disclose  the  presence  of  human  remains^  (Case 
24).  A  chemical  analysis  of  the  ashes  also  will  aid  in  estab- 
lishing this  fact.  In  cases  where  cremation  of  the  body  has 
been  resorted  to  to  conceal  crime,  the  length  of  time  necessary 
to  entirely  consume  the  human  body  may  become  an  important 
question.  A  period  of  less  than  ten  hours  has  been  proven 
sufficient.^ 

'Caspar,     "Forensic    Medicine,"  ^Report   of  the    "Druse     Case." 

vol.   i. ,    p.   314;   Schjerning,  Vier-  Trans.  New  York  State  Med.  Soci- 

teljahr.  fiir  gericht.  Med., xli.,  1884.  etj'.  1887,  p.  417. 

-The    "Parkman   Case, "  Boston,  •* See  the  Druse  Case  above. 
1850. 


PERIOD  OF  THE  OCCURRENCE  OF  DEATH.        (JiO 


Period  of  the  Occurrence  of  Death, 

As  already  indicated,  death  may  occur  from  direct  causes 
during  the  first  forty-eight  hours  after  the  infliction  of  the 
burn,  or  may  take  place  during  a  period  extending  from  the 
second  daj'  to  the  fifth  or  even  the  sixth  week.  In  the  great 
majority  of  cases  the  fatal  result  occurs  during  the  first  five  or 
six  days.  In  some  instances  it  may  be  important  to  establish 
the  fact  as  to  how  long  after  the  infliction  of  the  hum  the 
person  may  have  survived. 

Inflammation  and  suppuration  would  not  ordinarilj'  begin 
until  about  the  third  day,  hence  the  existence  of  this  condition 
would  indicate  that  the  person  had  probably  lived  two  days  or 
more;  and  the  state  of  advancement  of  these  processes  would 
afford  some  further  evidence.  The  existence  of  intestinal  in- 
flammations and  ulcerations,  which  require  some  days  for  their 
appearance  and  development,  would  also  give  some  indication 
of  the  probable  time  elapsing. 

WAS  THE   BURN  ANTE   MORTEM  OR  POST  MORTEM  ? 

In  describing  the  anatomical  characters  of  a  burn  occurring 
during  life,  vesication,  the  formation  of  blisters,  is  regarded 
as  a  marked  symptom. 

While  it  is  not  an  invariable  result  in  a  burn  of  the  living 
bod\%  it  is  so  constant  as  to  become  one  of  the  most  important 
factors  in  answering  the  question  as  to  the  ante-  or  post-mortem 
infliction  of  the  burn.  Where  the  burn  has  been  caused  by  a 
scalding  fluid,  or  by  burning  of  the  clothing,  or  the  direct  ap- 
plication of  flame,  blisters  are  more  likel}^  to  occur  than  where 
contact  with  a  highly  heated  body  has  taken  place.  In  the 
formation  of  a  blister  the  cuticle  is  raised  from  the  derma  or 
true  skin  by  the  effusion  of  a  highly  albuminous  serum,  and 
the  surrounding  skin  is  of  a  bright  or  copper}^  red  color.  The 
time  of  the  appearance  of  such  a  blister  is  not  fixed.  It  may 
occur  almost  immediatel}'  or  may  not  do  so  for  several  hours, 
an  interval  sufficiently  long  for  death  to  occur  from  shock.  It 
must  be  remembered  that  a  burn  inflicted  in  a  condition  of 
great  depression  of  the  vital  powers  with  insensibility  may  be 


GoO  HEAT  AND  COLD — STODDARD. 

followed  by  no  vesication  or  redness,  but  upon  reaction  and 
return  of  sensation  both  redness  and  blisters  may  appear 
(Case  17).  In  the  absence  of  blisters,  therefore,  it  cannot  be 
decided  that  for  this  reason  the  burn  was  post  mortem. 
If  from  a  blister  formed  on  the  living  body  the  cuticle  be  care- 
fully removed,  the  site  of  the  blister  will  present  an  intensely 
reddened  base.  In  the  dead  body,  if  the  cuticle  be  removed,  no 
red  base  appears,  but  the  surface  of  the  blister  becomes  dry  and 
of  a  grayish  color. 

On  the  other  hand,  if  the  presence  of  blisters  is  noted,  can 
it  be  concluded  that  the  burn  was  ante  mortem?  While  their 
presence  affords  reason  for  an  affirmative  answer,  careful  exam- 
ination of  the  blisters  as  to  their  character  and  contents  must 
be  made  in  order  to  decide ;  the  presence  of  apparent  blisters  is 
not  alone  sufficient  (Cases  20,  18;  Plate  II.). 

Elaborate  experiments  have  been  made  in  order  to  decide  the 
possibility  of  producing  blisters  post  mortem. 

Leuret,'  in  experiments  upon  dropsical  subjects  twenty-four 
hours  after  death,  shows  the  possibility  of  raising  a  blister 
post  mortem,  but  one  which  can  be  distinguished  from  one  of 
ante-mortem  production,  in  that  it  contains  a  reddish  serum 
very  slightly  albuminous.  He  urges  extreme  care  in  deciding 
this  question. 

Christison '  found  it  impossible  to  produce  a  blister  a  few 
hours  after  death.  In  a  patient  unconscious  from  narcotic 
poison,  heat  applied  four  hours  before  death  produced  a  blister 
and  a  red  line  was  formed  around  the  burns.  In  the  burns  pro- 
duced half  an  hour  after  death,  in  the  same  patient,  blisters 
formed  in  two  places  only,  and  these  were  covered  by  dry  skin 
and  contained  air.     No  redness  appeared  around  them. 

Champouillon  ^  agrees  with  Leuret  in  his  conclusions,  from 
experiments  upon  dropsical  subjects. 

Kosack  ^  considers  blisters  with  albuminous  contents  diag- 
nostic of  burns  during  life,  but  states  the  necessity  for  care  in 
deciding  in  the  absence  of  other  signs  of  reaction. 

Wright '  was  able  to  produce  blisters  three  and  a  half  hours 

'  Annales   d'Hygiene,    1835,    ii.,  ^  Friedrich's   Blatter   f.    gericht. 

p.  387.  Med.,  1877,  Heft  iii.,  p.  210. 

'^Edinb.  Med.  and  Surg.  Journal,  ""Path.  Research,  on  Vital   and 

Tol.  XXXV.,  p.  320,  April,  1831.  Post-Mortem  Burning, "  1850. 

2  Ann.  d'Hygiene,  1846,  i.,  p.  320. 


WAS   THE   BURN   ANTE   MORTEM   OR   POST   MORTEM?        651 

after  death  containing  a  small  quantity  of  pale  serum.  On 
the  same  body,  similar  experiments  fifteen  hours  after  death 
produced  blisters  containing  no  serum. 

Caspar  '  states,  as  a  result  of  experiments,  that  blisters  may 
be  produced  b}^  flame  after  death ;  that  they  result  from  vapor- 
ization of  the  fluid  beneath  the  cuticle  by  the  heat  employed ; 
that  they  are  not  found  to  contain  serum  and  no  line  of  redness 
is  found  at  their  base.  The  presence  after  death  of  vesications 
containing  serum  and  surrounded  by  a  reddish  base  is  an  evi- 
dence that  the  burn  was  inflicted  ante  mortem.  He  distinctly 
says :  "  It  is  quite  impossible  to  confound  a  burn  inflicted  dur- 
ing life  with  one  inflicted  after  death. " 

Woodman  and  Tidy,^  in  an  extended  series  of  experiments, 
conclude  that  while  blisters  can  be  produced  post  mortem,  they 
are  readily  distinguished  from  those  formed  ante  mortem  in 
containing  no  serum;  and  even  in  dropsical  subjects,  where 
blisters  containing  some  fluid  were  formed,  the  presence  of  but 
a  mere  trace  of  albumin  was  shown;  and,  in  all,  no  redness 
about  the  base  of  the  blisters  was  produced,  nor  any  appearance 
of  redness  after  removal  of  the  cuticle, 

Taylor  ^  has  never  observed  vesications  in  post-mortem  ex- 
periments on  infants.  He  cites  a  case  of  drowning  where  the 
person,  "pulseless  and  apparently  dead,"'  was  imprudently 
placed  in  a  hot  bath.  Blisters  containing  blood}^  serum  were 
formed  over  several  portions  of  the  bod3^  He  concludes  that 
hot  water  on  the  living  and  recently  dead  body,  so  far  as  vesi- 
cation is  concerned,  produces  similar  effects. 

In  experiments  on  the  dead  body  immediately  after  death 
the  writer  has  failed  to  produce  any  blister  containing  serum 
or  fluid.  The  so-called  blisters  are  produced  by  the  rapid  ex- 
pansion and  evaporation  of  the  fluid  beneath  the  cuticle  over 
the  portion  to  which  the  heat  was  applied,  and  differ  distinctly 
from  blisters  caused  during  life,  in  the  absence  of  serum  or  any 
redness  of  adjacent  or  subjacent  parts  (Plate  II.). 

Chambert^  concludes  that  in  living  bodies  and  in  dead 
bodies  within  twenty-four  hours  after  death  blisters  can  be 
produced,  and  that  less  heat  will  develop  them  in  the  living. 

'■'Forensic    Medicine,"  vol.   iv. ,  ''"Med.     Jurisprudence,"    Amer. 

p.  399.  Ed.,  lyyo,  p.  40S. 

-"Forensic  Medicine,"  Ed.  1877,  ^  Aniialos     d'Hygiene,    1859,    2d 

p.  886.  ser.,  xi.,  343,  379. 


652  HEAT    AND    COLD — STODDARD. 

He  specially  emphasizes  the  difference,  in  the  albuminous  char- 
acte:  of  the  contents,  of  a  blister  formed  ante  mortem  and  of 
one  formed  post  mortem. 

Jastrowitz  '  emphasizes  the  difference  between  blisters  formed 
during  life  and  those  occurring  in  oedematous  conditions. 

Blisters  are  to  be  distinguished  from  the  bullae  arising  from 
putrefaction.  There  is  little  danger  of  confounding  such  cases. 
In  conditions  of  putrefaction  no  redness  or  line  of  demarcation 
exists,  and  the  green  discoloration  and  other  conditions  of  the 
skin  will  suffice  to  establish  the  diagnosis. 

Schjerning  ^  considers  blisters  containing  highly  albuminous 
serum  as  diagnostic  of  burns  produced  during  life.  In  some 
conditions  of  depression  of  nutrition  blisters  occasionally  form, 
but  are  not  liable  to  be  confounded  with  those  caused  by 
burning. 

A  second  anatomical  feature  of  much  importance,  even  more 
so  than  vesication,  is  the  condition  of  the  skin  to  which  the 
heat  was  applied.  It  assumes  a  dusky  red  color  and  a  dry 
and  parchment-like  condition  (Case  8).  Surrounding  this  is 
an  area  of  grayish-white  skin  bounded  by  a  sharply  defined 
and  deeply  injected  red  line,  which  in  turn  shades  into  the 
color  of  the  surrounding  skin.  These  features  are  more  or  less 
pronounced  according  to  the  degree  of  heat  applied  and  to  the 
length  of  time  of  contact ;  or,  in  other  words,  to  the  depth  and 
severity  of  the  burn  (Plate  I.). 

MEANS  OF  DISTINGUISHING   ANTE-MORTEM   FROM  POST- 
MORTEM  BURNS. 

Differentially,  a  distinction  is  to  be  made  between  the  sur- 
rounding redness  and  the  line  of  redness.  The  redness  due 
to  capillary  distention  is  transient,  disappears  under  pressure 
during  life,  and  fades  after  death.  The  line  of  redness  is  per- 
manent, changing  but  little  under  pressure,  and  remains  after 
death.  It  is  a  vital  reactionary  effort,  a  true  line  of  separation 
between  living  and  dead  tissue,  formed  in  the  same  manner  as 
the  line  of  demarcation  in  sphacelus  or  gangrene.  This  line 
of  redness,   developed  only  during  life   and   permanent  after 

'  Vierteljahr.    f .   gericht.     Med. ,  -  Eulenb. ,  Vierteljahr.  f .  gericht. 

Bd.  xxxvi.,    Heft  i.,   1880.  Med.,  xii.,  1885,  xlii.,  1887. 


MEANS   OF   DISTINGUISHING   BURNS.  053 

death,  is  of  great  significance  in  cases  with  a  medico-legal 
bearing.  It  has  been  already  stated  that  in  persons  in  a  con- 
dition of  depressed  vitality  the  appearance  of  redness  and  vesi- 
cation is  sometimes  very  tardy  and  imperfect,  and  that  death 
from  shock  or  pain  may  occur  before  their  development  at  all. 
They  are  vital  processes  and  require  time  for  their  appearance 
in  proportion  to  the  activity  of  the  powers  of  reaction.  Hence 
in  cases  of  burning  resulting  fatally  where  vesication  and  red- 
ness do  not  appear,  the  circumstances  must  be  carefully  con- 
sidered before  deciding  that  the  burns  produced  were  post 
mortem.  With  these  qualifications,  it  may  be  stated  that  the 
presence  of  the  red  line  is  almost  uniform  in  burns  inflicted 
during  life  and  absent  in  those  occurring  after  death. 

If  upon  a  body  bearing  evidences  of  exposure  to  heat  there 
be  found  blisters  containing  highly  albuminous  serum,  and  such 
blisters,  after  the  removal  of  the  cuticle,  present  a  bright  red 
base  surrounded  by  a  bright  and  sharp  line  of  demarcation, 
with  redness  of  adjacent  surface,  we  are  justified  in  concluding 
that  the  burns  were  inflicted  ante  mortem  or,  at  farthest,  within 
a  few  moments  of  death.  If,  on  the  contrary,  the  red  line  is 
absent  and  the  blisters  contain  a  thin  watery  fluid,  with  a  yel- 
lowish and  dry  condition  of  their  base  after  removal  of  the 
cuticle,  the  presumption  is  that  the  burning  occurred  post 
mortem. 

Where  a  number  of  burns  are  found  upon  a  body,  the  ques- 
tion whether  they  were  produced  simultaneously  may  be 
raised.  This  can  be  answered  by  examination  as  to  their  con- 
dition. If  some  show  signs  of  recent  infliction,  while  others 
are  in  conditions  of  suppuration  or  other  changes  which  only 
occur  after  an  interval,  a  difference  of  time  in  production  would 
be  probable.  But  if  all  present  mainly  the  same  conditions, 
the  probability  of  their  occurring  at  the  same  time  may  be  con- 
cluded (Plates  I.  and  II.). 

The  Condition  of  the  Blood.— Special  examination  of 
the  blood  of  persons  dying  from  the  effect  of  bums  has  been 
made  by  competent  observers.  While  it  is  not  at  present 
possible  to  define  an  exact  and  constant  condition,  speciallj'- 
characteristic,  some  features  of  interest  have  been  recently 
recorded. 

The  color  of  the  blood  has  been  variously  reported ;  in  some 


654  HEAT    AND    COLD — STODDARD. 

cases  as  being  of  a  dark  color  and  in  others  of  a  bright  ar- 
terial hue.  Death  by  asphyxia  or  suffocation,  by  the  depriva- 
tion of  oxygen,  and  by  the  products  of  combustion,  would  be 
accompanied  by  a  dark  or  venous  hue  of  the  blood.  An  atmos- 
phere containing  an  excess  of  carbon  monoxide,  resulting  from 
combustion,  would  cause  death  by  apnoea  with  an  arterial  hue 
to  the  blood.'  But  other  influences  must  be  considered.  Ac- 
cording to  Schjerning,^  it  is  difficult  to  deduce  positive  conclu- 
sions from  the  condition  of  the  blood.  The  changes  induced  by 
the  spleen  and  kidneys,  as  well  as  the  varying  intensity  of  the 
degree  of  heat  to  which  the  body  may  be  subjected,  tend  to 
render  positive  and  constant  conclusions  from  this  source  dif- 
ficult. 

Falk  ^  refers  to  the  bright  red  color  of  the  blood  found  in 
some  cases,  and  explains  this  condition  in  part  by  the  influence 
of  chemical  changes  in  the  tissues  surrounding  the  vessels. 

Wertheim  *  describes  certain  conditions  observed  by  him 
and  mentions  an  increase  in  the  number  of  the  leucocytes,  to- 
gether with  the  presence  of  haemoglobin  and  melanin. 

Hoppe  Seyler  meets  with  similar  results  and  arrives  at  the 
same  conclusions  in  his  observations. 

Ponfik,'on  the  contrary,  is  doubtful  of  the  constant  presence 
of  some  of  these  conditions  and  also  of  their  diagnostic  value. 

Seliger "  confirms  the  conclusions  of  Wertheim,  in  that  he 
describes  the  presence  of  crystalline  bodies  and  of  dark  dis- 
colorations  (melanin). 

Some  spectroscopic  analyses  have  disclosed  the  presence  of 
bands  additional  to  those  of  normal  blood.  The  lack  of  uni- 
formity of  conditions  described  and  of  conclusions  reached 
leaves  the  subject  in  a  position  of  uncertainty.  Examination  of 
the  blood  of  those  dying  from  burns  has  not  been  so  exten- 
sively and  minutely  followed  as  to  enable  us  to  decide  questions 
which  may  arise  in  any  case. 

^Tidy,   "Legal  Med.,"  vol.   i.,  p.  -iWien.     med.    Presse,   1868,    pp. 

108  ;   also  Buzzard,  London  Lancet,  309,  605. 

vol.  i.,  p.  60,  1863.  ^Berliner      klinische      Wochen- 

«Euienberg's  Vierteljalir.  f.  ger-  schrift,  1876,  No.  17:  1877,  No.  46. 

icht.  Med.,  xli.,p.  4A  et  seq.  ''Eulenberg's  Vierteljahr.  f.  ger- 

3  "  Die  Verbrennungen  und  Ver-  icht.  Med. ,  xlii. ,  p.  47. 
briihungen. " 


EXPLANATION   OF   PLATE   IL 


FIGURE   1.— ANTE-MORTEM   BURN. 

Scald  by  steam  from  a  boiler  bursting,  July,  1892. 

From  a  photograph  taken  sixty  hours  after  the  accident.  The  in- 
jury covered  one-half  of  the  surface  of  the  body.  The  red  line  is 
sharply  marked  ;  the  extensive  blisters  formed  are  broken  and  their 
contents  have  escaped  ;  the  serum  drying  has  produced  yellowish  dis- 
colorations;  the  blush  of  redness  on  adjacent  parts  is  well  marked. 
Death  resulted  on  the  fifth  day. 

FIGURE  2.— POST-MORTEM   BURN. 

Exp.  1.  (Appearances  after  application  of  a  tin  can  containing 
boiling  water.)  The  cuticle  was  raised  by  expansion.  The  blisters 
contained  no  serum  and  no  red  line  is  developed 

FIGURE  3.— POST-MORTEM   BURN. 

Exp.  2.  (Appearances  after  the  application  of  iron  at  a  dull  red 
heat.)  No  proper  blister  formed;  the  cuticle  was  raised,  as  in  pre- 
vious experiment.  There  was  no  serum  and  no  red  line  or  redness 
of  adjacent  parts.  The  cuticle  is  charred  at  one  point,  where  the  iron 
was  brought  into  contact  with  it. 


MEDICAL  JURISPRUDENCE— PLATE 


"5^1^    ^^ 


Burn,  Two  hours  after  death,  by  Iron  at  a  dull  red  heat. 


■<«  jS' 


Burn,  Two  hours  after  death,  by  Tin  Can  containing  boiling  water. 


tftiOL 


Burn  by  Steam,  Sixty  hours  after  injury. 
POST-MORTEM  AND  ANTE-MORTEM   BURNS. 


WAS    DEATH    ACCIDENTAL?  657 


WAS   DEATH    ACCIDENTAL,  SUICIDAL,  OR   HOMICIDAL  ? 

Nearly  all  deaths  occurring  from  burning  are  accidental, 
very  few  homicidal,  and  hardly  more  than  a  few  exceptional 
cases  suicidal. 

It  is  important  in  cases  of  legal  investigation  to  note  the 
position  of  the  body  when  found  and  its  relation  to  the  ap- 
parent source  of  fire;  the  parts  of  the  body  and  clothing  burned, 
etc. ;  evidences  of  violence  should  be  carefully  observed,  such 
as  contusions,  fractures  of  bones,  wounds  of  the  soft  parts, 
evidences  of  strangling,  etc.  (Case  22).  These  should  be  spe- 
cially sought  in  the  site  of  the  burned  portions,  as  burning  and 
cremation  of  the  victim  are  sometimes  a  resort  to  conceal  homi- 
cide. In  considering  the  character  of  the  apparent  wounds,  it 
must  be  remembered  that  extensive  injuries,  resembling  wounds, 
may  result  from  the  effects  of  fire,'  and  these  must  be  carefully 
distinguished. 

Inability  to  detect  special  marks  of  violence  need  not  preclude 
the  possibility  of  its  commission  and  of  its  being  a  possible  cause 
of  death  (Case  19).  The  parts  burned,  the  character  and 
depth  of  the  burns,  and  their  relation  to  the  apparent  source  of 
burning,  with  consideration  of  their  probable  simultaneous  ex- 
posure, are  all  circumstances  of  weight  in  forming  an  opinion. 
The  position  of  the  body  in  relation  to  the  fire  should  also  be 
considered.  In  accidental  burning,  except  in  cases  of  intoxica- 
tion, epileptic  seizures,  or  other  sources  of  helplessness,  the  vic- 
tim is  quite  likely  to  be  found  at  a  distance  from  the  fire,  owing 
to  his  efforts  to  escape. 


CASES. 

Case  1.  Death  from  Cold.  Accidental  (Dr.  Hilty  in  Caspar's 
Vierteljahrschrift,  II.,  1865,  p.  140). — Male,  a!t.  52;  intoxicated. 
Severe  winter  weather ;  death  from  exposure.  Post  mortem  :  Blood 
crimson  ;  both  sides  of  heart  full ;  internal  organs  congested. 

Case  2.  Criminal  Exposure  to  Cold  {Ann.  d' Hygiene,  1868, 
Vol.  II.,  p.  173). — Girl,  unmarried;  sudden  delivery  when  at  stool. 
She  stated  that  she  had  fainted,  and  found  the  child  dead  when  she  re- 

'See  page  043  of  this  section 
42 


658  HEAT  AND  COLD — STODDARD. 

covered.  The  child  had  breathed  and  the  cord  was  cut.  No  marks  of 
violence.  Evidence  of  death  being  caused  by  wilful  exposure.  Im- 
prisoned. 

Case  3.  Ill-Treatment  and  Criminal  Exposure  (Ann.  d'' Hy- 
giene, Vol.  VI.,  p.  207,  1831). — Man  and  wife  tried  for  manslaughter 
of  a  child,  aet.  11.  Wife  the  stepmother.  Starvation  and  ill-treatment 
by  mother,  followed  by  forcing  the  child,  in  a  cold  December  day,  to 
get  into  a  barrel  of  cold  water  and  remain  there.  Though  removed  by 
a  servant,  she  was  again  placed  in  the  cold  water  by  the  mother,  death 
resulting.     The  woman  was  sentenced  to  life  imprisonment. 

Case  4.  Sunstroke,  High  Temperature,  etc.  (Dr.  A.  Flint,  Jr., 
Neiv  York  Med.  Jour. ,  1872,  p.  168  ;  Dr.  Katzenbach,  New  York  Med. 
Jour.,  1873,  p.  93). 

Case  5.  Scald,  Drinking  from  a  Tea-kettle.  Accidental  (Mr. 
Sympson,  Brit.  Med.  Jour.,  1875,  June  19th,  p.  809).— Boy,  set.  2k 
years,  drank  boiling  water  from  spout  of  tea-kettle.  Inflammation  of 
pharynx  and  glottis.     Tracheotomy  ;  recovered. 

Case  6.  Fatal  Scald  of  Insane  Person  in  a  Bath  (Brit.  Med. 
Jour.,  April,  1871,  p.  456). — ^An  insane  patient  fatally  scalded  in  a  bath, 
through  carelessness  of  an  attendant.  The  charge  of  manslaughter 
brought  against  the  attendant. 

Case  7.  Fatal  Burn  of  Genitals.  Accidental  (Caspar,  "Forensic 
Med.,"  Vol.  I.,  p.  315).— Female  child,  2h  years,  fell  on  a  hot  flat- 
iron.  Genitals  burned  ;  died  in  eleven  days.  Vagina  gangrenous  ; 
blood  fluid  ;  lungs  aneemic  and  pale  ;  trachea  bright  red,  etc. 

Case  8.  Red,  Parchmenty  Skin,  Cracks,  etc.  (Caspar,  "Forensic 
Med.,"  Vol.  I.,  p.  307). — While  a  chimney-sweep  was  cleaning  a  chim- 
ney a  fire  was  lighted  below.  Death.  The  entire  skin  was  of  a  coppery 
red  color,  with  yellow  patches.  No  carbonization.  Skin  parchmenty, 
with  fissures  upon  the  edges  of  which  the  fat  had  melted  and  flowed 
out. 

Case  9.  Asphyxia.  *Soo^?/ Mwcits,  eic.  (Caspar,  "Forensic  Med.," 
Vol.  I.,  p.  314). — Two  children,  aet.  3  and  7,  burned;  death  from 
asphyxia.  The  youngest,  the  girl,  burned  externally ;  the  boy  was 
not.  Post  mortem  in  both  showed  the  trachea  to  contain  frothy  and 
sooty  mucus.  Lungs  and  vessels  of  thorax  and  abdomen  distended 
with  dark  and  fluid  blood.     Brain  congested,  etc. 

Case  10.  Burn  of  Body.  Inflam,mation  of  Stomach  (Ainer.  Jour. 
Med.  Sciences,  Jan.,  1861,  p.  137). — Superficial  burn  of  lower  part  of 
hody.  Death  on  the  thirteenth  day.  Post-mortem  examination 
showed  the  stomach  inflamed  and  the  intestines  also. 

Case  11.  Accidental  Scald.  Pleurisy  (Caspar,  "  Forensic  Med.," 
Vol.  I.,  p.  312). — Female  child,  a?t.  6;  scalded  with  a  pot  of  boiling 
coffee  overturned  upon  the  side  of  neck,  right  axilla,  thorax,  and  right 
arm.  Death  on  the  eighth  day.  Post-mortem  examination  revealed 
inflammation  of  right  jfleura,  pericardial  effusion,  etc.     Body  ansemic. 


CASES.  659 

Case  12.  No  Internal  Lesion  Found  (Guy's  Hospital  Reports, 
1860,  Vol.  VI.,  p.  146). —Female,  ait.  9.  Burn  of  upper  part  of  chest 
and  arms  by  clothing  taking  fire.  Death  on  the  ninth  day.  Post- 
mortem examination  revealed  no  lesion  of  the  internal  organs. 

Case  13.  Cracks  and  Fissures  of  Skin  (Caspar,  "  Forensic  Med.," 
Vol.  I.,  p.  314).— Male,  aet.  83.  Clothing  caught  fire;  death.  Body 
carbonized.  On  right  side  were  fissures  opening  into  the  abdomen  ; 
the  viscera  could  be  seen,  etc. 

Case  14.  Fissures,  Vessels  Crossing,  etc.  (Taylor,  "  Med.  Jurispru- 
dence," Vol.  I.,  p.  696). — Boy,  set.  2;  death  in  three-quarters  of  an 
hour.-  On  legs  were  fissures  and  lacerations  near  each  knee.  On 
right  thigh  a  laceration  2f  inches  long,  \  inch  deep  and  \  inch  wide  ; 
fatty  tissue  seen  beneath.  No  blood  efi'used  ;  small  vessels  could  be 
seen  stretching  across  the  fissures. 

Case  15.  Brain  Congested,  etc.  (Caspar,  "  Forensic  Med.,"  p.  316, 
Vol.  I.). — Boy,  aet.  1^  years,  set  fire  to  his  clotliing.  Death  in  1^ 
days.  Post-mortem  examination  showed  congestion  of  the  brain,  in- 
flammation of  the  trachea,  engorgement  of  the  lungs  with  hepatization 
of  the  lower  part  of  the  right  lung. 

Case  16.  Burn  of  Loicer  Part  of  Body.  Death  (same  reference). — 
Woman,  tet.  81 ;  burn  of  lower  part  of  body,  including  the  gluteal  re- 
gion, the  perineum  and  genital  organs  (external).  Death  after  several 
days.  Post-mortem  examination  showed  the  upper  lobe  of  left  lung 
in  a  stage  of  red  hepatization,  etc. 

Case  17.  Tardy  Appearance  of  Redness  and  Vesication  (Tidy, 
"Legal  Med.,"  Vol.  II.,  p.  124,  Case  15).— Woman,  insensible  from 
cold,  had  hot  water  applied  in  tins  to  her  sides  and  feet.  The  flannel 
coverings  became  displaced  and  the  hot  tins  came  in  contact  with  the 
body.  No  redness  or  vesication  could  be  detected  two  hours  after- 
ward. The  next  day,  when  consciousness  had  returned  and  recovery 
from  insensibility  had  taken  place,  the  parts  had  become  reddened 
and  vesicated. 

Case  18.  Were  the  Burns  Ante  Mortem  or  Post  Mortem  f  (Caspar, 
"Forensic  Med.,"  Vol.  I.,  p.  317). — Woman  intoxicated;  clothing 
caught  flre ;  death  due  to  asphyxia.  Some  burns  apparently  caused 
during  life  and  some  after  death.  The  case  was  decided  upon  the 
character  of  the  vesications  and  their  contents.  Lungs  and  other  or- 
gans normal.     Right  side  of  heart  engorged  with  dai-k  blood. 

Case  19.  Murder.  Body  Burned  (Dr.  Duncan,  Med.  Gazette, 
Lond.,  Vol.  VIII.,  p.  170). — Man  chai'ged  with  the  murder  of  his  wife 
and  attempting  to  burn  the  body  afterward.  The  body  was  so  exten- 
sively burned  as  to  remove  all  means  of  deciding  the  cause  of  death. 
The  man  claimed  that  her  clothing  took  fire  when  she  was  intoxicated. 
Persons  in  the  same  house  had  heard  sounds  of  a  struggle  before 
smelling  smoke  and  fire.  Furniture  was  not  burned,  nor  the  house. 
The  prisoner  was  found  guilty  of  murder. 


GCO  HEAT  AND  COLD — STODDARD. 

Case  20.  Blisters.  Was  the  Scalding  Ante  Mortem  f  (Taylor, 
"Med.  Jurisprudence,"  8th  Am.  Ed.,  p.  411). — The  body  of  an  infant 
found  in  a  saucepan,  boiled.  The  prisoner  admitted  that  the  child  had 
breathed.  The  boiling  water  had  destroyed  the  means  of  positively 
deciding  whether  the  child  had  breathed.  Blisters  found  upon  it  con- 
tained yellow  serum.  Was  the  child  living  when  put  in  the  water  ? 
The  prisoner  was  acquitted. 

Case  21.  Scald  of  a  Lunatic  in  a  Bath  (Taylor,  ' '  Med.  Jurispru- 
dence," 8th  Am.  Ed.,  p.  411). — Insane  patient  placed  in  a  hot  bath. 
Temperature  123"  F.     Death  in  collapse  next  day  (1879). 

Case  22.  Criminal  Burning,  Strangling  (Report  of  Profs.  Liebig 
and  Bischoff,  of  Giessen,  March,  1850). — The  man  StauflF  was  tried  at 
Darmstadt  for  the  murder  of  the  Countess  of  Goerlitz,  whom  he  had 
attacked  and  murdered  in  her  chamber,  and  then  fired  the  furniture 
in  order  to  conceal  the  crime.  It  was  uncertain  whether  she  had  died 
from  injury  to  the  head  or  from  strangulation.  The  tongue  protruded 
and  was  swollen,  as  in  cases  of  strangling,  and  maintained  this  con- 
dition. He  was  convicted  chiefly  on  circumstantial  evidence.  After 
conviction  he  confessed  that  he  had  strangled  her  and  then  set  fire  to 
the  furniture,  which  he  had  piled  up  about  her. 

Case  23.  Murder.  Body  Burned.  Identified  ("Report  of  the 
Trial  of  Prof.  Webster,"  etc.,  Boston,  1850).— Prof.  Webster  kiUed  Dr. 
Parkman  and  then  burned  the  body,  in  portions,  in  a  furnace  in 
his  laboratory.  Search  among  the  cinders  of  the  furnace  disclosed 
pieces  of  human  bones  and  a  set  of  false  teeth  which  the  dentist  who 
made  them  recognized  as  made  by  him  for  Dr.  Parkman,  etc. 

Case  24.  Murder.  Body  Eyitirely  Burned.  Identified  (the 
"Druse  Case,"  Trans.  New  York  State  Med.  Soc,  1887,  p.  417).— 
Mrs.  Druse,  with  the  compulsory  aid  of  her  children,  killed  her  hus- 
band with  an  axe.  The  body  was  burned  in  a  wood  stove,  with  pine 
shingles.  Tlie  ashes  were  thrown  into  a  swamp  near  by.  They  were 
found  and  carefully  sifted.  Pieces  of  bone  of  various  sizes,  identified 
as  human,  were  found,  as  also  a  few  porcelain  buttons,  etc.  A  few 
hairs  found,  with  stains,  completed  the  identity.  Experiments  in  this 
case  showed  that  the  body  could  have  been  consumed  within  ten 
hours.     The  prisoner  was  convicted  of  murder. 


THE   MEDICO-LEGAL   RELATIONS 

ELECTRICITY. 


BY 

WILLIAM    N.   BULLARD,   M.D. 


MEDICO-LEGAL  RELATIONS  OF 
ELECTRICITY. 

As  the  frequency  of  accidents  caused  by  electricity  is  rap- 
idly increasing,  we  have  of  late  years  been  enabled  to  general- 
ize in  a  manner  never  before  possible  in  regard  to  their  results, 
and  although  our  present  conclusions  must  be  recognized  as 
provisional  and  perhaps  temporary — to  be  changed  or  modified 
in  accordance  with  future  knowledge — yet  we  have  obtained  a 
basis  of  fact  on  which  we  can  securely  rely.  The  general  laws 
of  injury  and  accident  through  electricity  have  been  fairly  well 
determined,  although  many  of  the  details  are  not  3'et  thoroughly 
worked  out  or  understood.  The  advances  of  knowledge  in  this 
direction  are  so  rapid  that  an  article  on  this  subject,  if  it  deals 
too  closely  with  details,  is  liable  to  become  out  of  date  almost 
before  it  has  left  the  press.  Like  all  large  subjects  when  first 
made  objects  of  general  interest  and  investigation,  and  in 
regard  to  which  we  are  on  the  threshold  only  of  knowledge,  the 
facts  discoverable  may  lead  us  at  any  time  in  unexpected 
directions  and  open  out  new  fields  of  thought  and  inquiry.  We 
shall  try  to  limit  ourselves  here,  as  far  as  possible,  to  proved 
facts,  and  leave  questions  doubtful  or  in  dispute  to  be  settled 
later;  contenting  ourselves  merely  with  pointing  them  out  and, 
perhaps,  in  some  cases  giving  the  facts  on  either  side. 

Electrical  accidents  and  injuries  may  be  divided  into  those 
which  are  caused  by  the  atmospheric  electricity — lightning 
proper,  globes  of  fire,  St.  Elmo's  fire — and  those  produced 
through  the  agency  of  mechanical  or  artificial  electricity — elec- 
trical machines,  batteries,  dynamos,  etc.  The  effects  caused 
by  these  different  agents  probably  vary  only  in  degree:  the 
atmospheric  electricity  in  the  form  of  lightning,  etc.,  being  so 
much  more  powerful  than  the  charges  usually  produced  artifi- 
cially as  to  cause  some  difference  in  the  results. 


664  ELECTRICITY — BULLARD. 


BESULTS  OF  ACCIDENTS  AND  INJURIES  FROM  ELECTRICAL 
MACHINES   AND   CONDUCTORS. 

Medical  Electricity. — In  the  ordinary  use  of  the  mild 
forms  of  electricity  employed  for  medical  purposes,  certain 
phenomena  may  at  times  occur,  which,  although  not  of  any 
serious  import  or  of  long  duration,  may  yet  cause  considerable 
inconvenience,  pain,  or  discomfort  to  the  patient  or  others,  and 
may  even  be  of  some  importance  from  a  medico-legal  point  of 
view.  We  shall  not  enter  here  into  the  discussion  of  the  proper 
methods  of  application  of  medical  electricity,  nor  do  more  than 
point  out  that  if  these  be  not  followed  with  care  the  patient 
may  be  not  only  not  benefited,  but  made  worse,  and  may  even 
suffer  considerable  injury.  The  increase  of  pain  caused  b,y  the 
improper  application  of  certain  currents  is  usually  temporary 
and  of  minor  consequence.  But  serious  and  lasting  inflamma- 
tions may  be  caused  by  the  careless,  ignorant,  or  injudicious  use 
of  the  stronger  currents  internally,  and  metritis  and  peri-uterine 
inflammations  have  been  not  infrequently  reported  from  the 
unskilled  practice  of  the  methods  of  Apostoli.  These  subjects, 
however,  scarcely  come  under  the  scope  of  this  article. 

In  addition,  however,  to  these  troubles  we  may  have  ex- 
ternal injuries  produced.  Even  in  cases  where  the  current 
amounts  to  not  more  than  a  few  milliamperes  burns  may  be 
caused  by  the  ordinary  electrodes  of  the  galvanic  battery.  The 
faradic  current  when  medically  used  does  not,  as  a  rule,  pro- 
duce any  external  injuries.  Such  might  be  caused  by  a  spark 
from  a  static  machine,  but  it  would  be  due  to  gross  carelessness, 
and  is  very  unusual.  Burns,  however,  from  the  use  of  the 
galvanic  current  are  not  very  uncommon.  They  usually  occur 
under  the  electrode  after  it  has  been  for  a  few  moments  station- 
ary in  contact  with  the  skin.  They  occur  in  certain  patients 
with  extraordinary  readiness,  especially  in  those  with  organic 
spinal  lesions,  and  where  the  sensation  is  somewhat  diminished, 
and  where  also  some  trophic  lesion  might  be  supposed  to  exist. 
They  are  not  confined,  however,  to  this  class  of  cases,  but  may 
occur  in  any  one  if  the  electrode  be  retained  too  long  in  any  one 
place,  and  especially  if  it  be  allowed  to  become  dry.     These 


INJURIES   FROM   ELECTRICAL   MACHINES.  665 

burns  are  peculiar  in  appearance  and  can  usually  be  recognized 
at  once.  They  are  circular,  as  if  punched  out,  about  the  size  of 
a  common  pencil  or  a  little  smaller,  comparatively  deep,  gray 
with  perhaps  a  dark  ring  at  the  circumference,  and  frequently 
surrounded  by  a  reddened  area.  The  edges  are  sharp.  Their 
peculiarit}^  consists  (1)  in  their  painlessness  and  (2)  in  their 
size,  regular  form,  their  depth  in  comparison  to  their  extent, 
and  the  sharp  limitation  of  the  area  of  tissue  destroyed.  One 
or  more  may  occur  under  a  broad  electrode,  and  they  are  prob- 
ably produced  at  those  points  where  the  contact  is  imperfect  or 
the  conduction  in  some  other  way  impeded.  They  heal  without 
much  difficulty  and  leave  no  serious  results. 

Other  unpleasant  symptoms  produced  by  currents  in  medi- 
cal use  may  be  mentioned  for  the  sake  of  completeness,  and  also 
as  an  introduction  to  the  more  serious  symptoms  caused  by 
stronger  currents.  Dizziness,  vertigo,  tinnitus,  nausea,  vomit- 
ing, and  syncope  are  readily  caused  by  even  slight  currents. 
The  sensation  of  light  in  the  eyes  and  the  metallic  taste  in  the 
mouth  are  the  results  of  medical  currents  of  ordinary  strength 
when  applied  to  the  head  or  in  its  neighborhood,  and  stronger 
currents  applied  at  greater  distances  cause  these  sensations. 
All  the  above  symptoms  may  be  readily  caused  by  even  slight 
currents,  whether  galvanic  or  faradic,  passed  through  the  head. 
The  syncope  thus  produced  is  to  be  carefull}'  differentiated 
from  the  syncope  caused  psychically  by  excitement  or  fear  of 
the  application  of  electricity.  Hysterical  women,  and  even 
persons  who  show  no  special  signs  of  nervous  instability,  may 
faint  at  the  suggestion  of  the  application  of  electricity.  I  have 
seen  a  large,  strong,  well-built  Italian  man,  perfectl}'  sound  phys- 
ically, so  far  as  could  be  detected,  except  some  slight  local  neu- 
ralgia, faint  from  pure  fright  when  the  electricity  was  to  be 
applied.  But  even  the  application  of  moderateh'  severe  shocks 
from  the  ordinary  medical  batter}^  are  not  likely  to  produce 
serious  results.  These  shocks  are  ordinarily  caused  by  the 
opening  or  closing  of  the  galvanic  current,  and  are  most  severe 
when  the  current  passes  through  some  portion  of  the  head.  A 
still  more  powerful  shock  may  be  given  bj'  reversing  the  cur- 
rent in  a  galvanic  battery  by  means  of  the  commutator. 


666  ELECTRICITY — BULLARD. 


Currents  of  High  Tension — Strong  Artificial 
Currents. 

Passing  on  now  to  the  consideration  of  the  stronger  cur- 
rents, we  come  to  those  used  for  mechanical  purposes,  for  elec- 
tric lighting,  electric  railways,  and  other  analogous  objects. 
These  currents  start  from  dynamos  or  from  storage  batteries, 
and  accidents  are  caused  by  them  whenever  they  are  diverted 
from  their  proper  course  and  are  caused  to  come  in  contact 
with  or  to  pass  through  any  portion  of  the  human  body  in  any 
considerable  strength.  Accidents  not  infrequently  occur  from 
direct  contact  with  the  batteries  or  dynamos,  but  still  more  fre- 
quently they  are  produced  in  their  circuit  along  the  wires  or 
transmitters.  They  maj'  also  be  caused,  as  some  of  the  most 
fatal  have  been,  by  contact  with  metallic  or  other  readily 
conducting  objects  which  have  themselves  accidentally  come  in 
contact  with  some  portion  of  an  electric  circuit  (usually  wires) 
and  have  diverted  the  whole,  or  more  usually  a  portion,  of  the 
current  to  themselves.  Thus  was  killed  a  young  man  in  New 
York,  the  clerk  in  a  store,  who  while  lifting  the  metal-edged 
cover  of  a  show-case  brought  it  in  contact  with  the  charged 
wires  of  an  electric  light  and  received  an  immediately  fatal 
shock.  As  a  rule,  those  meeting  with  accidents  from  dynamos 
or  electric  machines  directly  are  employees  of  electric  com- 
panies, who  are  presumed  to  have  more  or  less  knowledge  of  the 
risk  of  carelessness,  or  they  may  be  workers  in  institutions  or 
factories  in  which  such  machines  are  in  use.  Many  of  the 
accidents  due  to  wires  also  occur  to  linemen  and  other  em- 
ployees of  electric,  telephone,  or  telegraph  companies  or  of  elec- 
tric railway  companies  in  charge  of  wires  or  electric  outfit.  So 
long  as  the  current  transmitters  and  terminals  (wires,  etc.)  are 
properly  insulated  and  in  their  proper  position  in  relation  to 
other  conductors,  it  is  unusual  for  accidents  to  occur,  except  in 
cases  of  gross  ignorance  or  carelessness.  Unfortunately,  how- 
ever, proper  insulation  is  not  always  accomplished,  and  fre- 
quently wires  and  other  transmitters  are  removed  from  their 
proper  positions  by  accidents  and  otherwise.  So  long  as  and 
wherever  the  system  of  overhead  wires  exists,  if  there  be  among* 
these  wires  any  which  are  the  transmitters  of  strong  electric 


CURRENTS   OF   HIGH    TENSION — INSULATION.  667 

currents,  there  is  alwaj's  a  risk,  and  often  a  very  serious  one, 
that  at  some  time  or  other  one  of  these  current-bearing  wires 
will  come  into  contact  with  some  other  non-current-bearing  and 
ordinarily  harmless  wire  in  such  a  manner  that  the  current  of 
the  first  should  be  diverted,  in  whole  or  in  part,  on  to  the  ordi- 
narily innocuous  wire,  which  thereby  becomes  at  once  charged 
and  dangerous.  Such  an  accident  may  be  due  to  the  displace- 
ment of  either  wire  or  to  any  other  cause  which  brings  the  two 
in  contact,  either  direct  or  indirect,  at  a  point  where  the  current- 
bearing  wire  is  not  sufficiently  insulated.  The  current  having 
once  passed  out  of  its  proper  circuit  will,  of  course,  follow  the 
paths  of  best  conduction,  and  may  hence  suddenly  appear  in 
unexpected  quarters  and  produce  the  most  dangerous  and  even 
fatal  effects.  It  is  accidents  of  this  character  which  most  fre- 
quently occur  among  the  people  who  are  neither  employees  of 
electric  companies  nor  engaged  in  factories  or  buildings  where 
electrical  machines  are  em^^loyed. 

Insulation  of  Wires  and  Other  Electrical  Trans- 
mitters.—We  cannot  mention  here  the  various  methods  em- 
ployed to  insidate  wires,  as  the  general  principles  of  insulation 
are  well  known.  Electric  wires  even  with  very  strong  currents 
can  be  insulated  and  can  be  kept  insulated  if  sufficient  pains  be 
taken  and  sufficient  money  be  expended.  But  this  is  very  ex- 
pensive and  in  many  cases  is  not  done.  Only  partial  insula- 
tion is  attempted,  and  even  this  is  not  always  carried  to  the 
degree  intended  or  stipulated.  Hence  so  long  as  overhead  wires 
of  various  kinds  exist,  accidents  from  the  transmission  of 
strong  electric  currents  along  ordinarily  harmless  wires  are 
liable  at  any  time  to  occur,  as  practically  little  or  no  attempt  at 
keeping  the  current-bearing  wires  covered  with  a  thoroughly 
insulating  material  is  in  most  cases  made.  It  is  usually  deemed 
sufficient  that  glass  or  other  insulators  should  be  so  placed  that 
under  ordinary  conditions  the  wire  will  not  come  into  contact 
with  any  conductor  which  may  cause  any  essential  part  of  its 
current  to  diverge.  In  most  cases  a  so-called  insulating  mate- 
rial is  placed  over  the  wire  itself,  but  this  usually  is  insufficient 
at  the  outset  or  becomes  so  before  very  long  and  is  then  not 
renewed. 

It  must  not  be  supposed,  however,  that  undergromid  electric 
wires  or  transmitters  cannot  produce  accidents.     On  the  con- 


668  ELECTRICITY — BULLARD. 

traiy,  the  current  may  be  diverted  from  them  to  the  gas  or 
water  pipes  or  to  any  other  conductors  which  come  into  contact 
with  them  or  can  attract  to  themselves  a  portion  of  their  cur- 
rent. Severe  shocks  have  been  experienced  by  persons  attempt- 
ing to  draw  water  at  their  faucet  from  causes  of  this  character. 
At  the  same  time,  so  far  as  mere  safety  is  concerned  and  free- 
dom from  electrical  accidents,  it  would  seem  that  underground 
wires  are  preferable  to  overhead  wires. 

Electrical  wires  have  not  infrequently  come  in  contact  with 
telegraph  and  telephone  wires  causing  unpleasant  results.  Tel- 
ephone boxes  have  been  set  on  fire,  and  also  telegraph  boards 
and  tables,  and  in  certain  cases  what  might  have  been  serious 
conflagrations  have  been  started  in  this  manner.  By  means  of 
proper  arrangements  on  the  telegraph  and  telephone  circuits 
these  dangers  can  be  at  least  partially  avoided,  but  there  is 
always  the  risk  that  the  automatic  alarms  and  other  contriv- 
ances do  not  act,  and  the  still  greater  one  that  persons  or  things 
may  come  into  contact  with  these  charged  wires  and  receive 
dangerous  or  serious  injuries. 

Electric  Cars. — The  danger  from  the  overhead  wires  in 
the  trolley  system  of  electric  cars  would  not  be  great  were  these 
wires  properly  supported,  properly  insulated,  and  properly  pro- 
tected. Each  of  these  terms  must  be  explained.  Wires  which 
fall  for  any  cause  whatever  short  of  being  intentionally  re- 
moved cannot  be  deemed  properl}^  supported  in  the  sense  in 
which  we  use  the  term.  Any  one  of  these  electric  wires  which 
falls  is  liable  to  produce  serious  injur}^  to  persons  or  animals 
(many  horses  have  been  killed  by  them),  or  to  set  fire  to  objects 
with  Avhich  it  comes  into  immediate  or  indirect  contact,  the 
amount  of  injury  being  in  part  dependent  upon  the  nature 
and  the  condition  (wet  or  dry)  of  the  object  and  its  position  in 
relation  to  other  conductors.  Wires  as  dangerous  as  these  car 
wires  should  be  so  supported  that  no  ordinary  accident,  no  con- 
dition of  the  weather,  strong  winds,  or  heavy  falls  of  snow 
should  be  capable  of  wrenching  them  from  their  supports,  and 
they  should  be  placed  in  such  positions  and  with  such  protec- 
tion as  not  to  receive  blows  from  passing  or  falling  objects. 

Secondly,  these  wires  should  be  properly  insulated.  This  is 
to  be  understood  to  mean  that  all  the  wires  which  carry  the 
electric  current,  or  are  liable  to  carr}-  it,  should  be  attached  to 


ELECTRIC    CARS.  669 

their  poles  or  other  support  in  such  a  manner  that  no  apprecia- 
ble quantity  of  electricity  is  under  any  circumstances  liable  to 
be  diverted  to  the  poles  or  supports,  and  in  this  way  cause  de- 
struction or  injury.  In  addition  to  this  the  side  wires  should 
be  so  covered  that  if  any  accident  occurs,  it  will  be  difficult  or 
impossible  for  the  current  to  pass  away  from  them  to  other 
objects.  The  middle  wire  on  which  the  trolley  runs  cannot  be 
thus  covered,  but  must  be  left  bare,  and  hence,  if  knocked  down 
or  brought  into  contact  with  properly  conducting  objects,  must 
be  the  most  dangerous ;  but  on  the  other  hand  from  its  position 
it  is  less  liable  to  accidents. 

When  we  say  that  these  wires  should  be  properly  protected 
we  mean  that  such  arrangements  and  contrivances  should  be 
used  as  will  prevent  them  while  in  their  usual  position  from 
coming  into  contact  with  dangerous  objects,  particularly  with 
other  wires.  This  may  be  accomplished  by  guard  wires  or  in 
other  ways.  It  is  plainly  of  great  importance  that  this  should 
be  specially  cared  for,  and  particularly  in  a  city  where  there  are 
many  overhead  wires,  and  perhaps  a  considerable  number  of 
dead  or  non-used  wires.  If  the  electricity  comes  into  contact 
with  one  of  these  no  one  can  tell  where  it  may  be  transmitted 
or  what  harm  it  may  do. 

The  principles  which  apply  to  these  overhead  wires  of  course 
apply  ceteris  paribus  to  all  other  electric  overhead  wires,  and 
in  like  manner  the  statements  made  in  regard  to  the  diffusion 
or  spreading  of  currents  in  underground  wires  are  applicable  to 
all  methods  of  transmitting  electricity  mechanically  through 
the  ground  so  far  as  the  conditions  are  similar.  An  electric 
current  will  always  follow  the  path  of  best  conduction,  and 
where  several  paths  are  opened  it  will  follow  them  proportion- 
ally according  to  the  excellence  of  their  conduction  or  inversely 
to  the  amount  of  their  electric  resistance. 

We  shall  not  enter  here  into  any  questions  in  regard  to  the 
diffusion  of  electricity,  its  transmission  through  fluids,  water, 
air  or  other  gases,  nor  shall  we  discuss  the  relations  of  good  or 
bad  conductors  to  electricity  except  so  far  as  this  relates  to 
certain  portions  of  the  human  body.  An  elementary  knowledge 
of  physics  and  electricity  must  be  presupposed. 

We  can  now  enter  more  directly  upon  the  immediate  sub- 
ject of  this  article,  that  is,  the  effect  upon  the  human  body  of 


670  ELECTRICITY — BULLARD. 

severe  or  moderately  strong  currents  of  electricity  derived  from 
artificial  sources.  The  accidents  produced  by  these  currents 
may  be  divided  into  two  classes,  the  direct  and  the  indirect. 
Under  the  direct  we  place  all  those  conditions  which  are  ap- 
parently produced  by  the  action  of  the  electricity  itself,  such  as 
the  general  shock,  the  loss  of  consciousness,  the  burns,  etc.  On 
the  other  hand,  all  those  accidents  are  to  be  considered  indirect 
which  are  not  primarily  due  to  the  action  of  the  electric  current, 
but  are  only  secondary  results  thereof.  These  are  largely  de- 
termined by  the  immediate  surroundings  and  conditions  at  the 
time.  Such,  for  example,  are  the  surgical  injuries  due  to  falls 
caused  by  the  loss  of  consciousness  produced  by  the  electric 
shock. 

Indirect  Accidents. 

These  will* be  considered  first,  as  they  do  not  demand  so  de- 
tailed a  description  as  the  direct.  They  are  traumatic  in  char- 
acter and  are  the  result  either  of  loss  of  consciousness,  momen- 
tary or  lasting,  or  of  the  involuntary  muscular  contraction 
which  may  be  occasioned  by  the  electric  shock.  They  are 
among  the  most  frequent  effects  of  severe  electric  shocks. 
These  accidents  consist  in  contusions,  fractures,  dislocations, 
wounds,  and  any  other  injuries  which  may  be  produced  from 
sudden  loss  of  consciousness  while  in  a  dangerous  position. 
Death  ma}^  readily  occur  either  immediately  or  as  the  more  or 
less  delayed  result  of  such  injuries.  If  the  person  shocked  falls 
into  the  water  he  may  be  drowned,  or  if  into  the  fire  he  will 
be  burnt.  The  varieties  of  such  accidents  dependent  on  the 
sudden  loss  of  consciousness  produced  by  the  electricity  are, 
of  course,  innumerable,  and  their  occurrence  must  largely  de- 
pend upon  the  position  of  the  victim  at  the  moment  of  the 
shock.  We  see,  perhaps,  most  of  these  accidents  in  linemen 
on  the  tops  of  poles  or  houses  or  in  other  exposed  places,  but 
persons  who  receive  shocks  when  simply  standing  on  the  ground 
or  when  sitting  are  not  exempt  from  severe  surgical  injuries 
other  than  burns.  They  are  often  cast  to  the  ground  with  great 
violence,  and  not  infrequently  are  thrown  to  a  distance  of  sev- 
eral feet.  This  is  caused  by  the  violent  muscular  contraction 
produced  by  the  electric  shock,  and  it  may  occasion,  like  any 


INDIRECT   ACCIDENTS — DIRECT    ACCIDENTS.  671 

violent  push  or  fall,  severe  injuries  from  contact  with  the  various 
objects  against  which  they  may  be  forced.  Although  much 
rarer,  it  is  also  possible  that  the  violence  of  these  muscular 
contractions  may  be  such  as  of  themselves  to  cause  injury,  as 
rupture  of  a  muscle  or  tendon.  As  practically  all  these  indirect 
accidents  are  traumatic  and  surgical  in  character,  thej'  do  not 
differ  from  other  accidents  similar  in  kind,  but  otherwise 
caused,  and  are  to  be  treated  on  the  same  general  principles  as 
these. 

Direct  Accidents. 

Quite  different  from  the  indirect  are  the  direct  accidents; 
those  produced  by  the  immediate  (direct)  action  of  the  electric- 
ity. These  are  of  various  kinds,  which  we  shall  consider  sepa- 
rately. They  maj'  be  divided  into  immediate  and  late  symp- 
toms, and  they  vary  much  according  to  the  severity  of  the  shock 
and  the  constitution  of  the  patient,  and  the  pftrt  of  the  body 
through  which  the  electricit}-  passes.  The  character  of  the 
current  which  gives  the  shock,  whether  constant  or  interrupted, 
also  naturally  has  an  influence  on  the  effect. 

General  Principles. — A  shock  may  be  given  in  three 
ways  with  an  ordinary  galvanic  battery.  If  the  current  be 
sufficiently  strong,  a  distinct  shock  will  be  produced  when  the 
circuit  is  closed  and  again  when  the  cii'cuit  is  opened,  while 
with  a  current  of  the  usual  strength  for  medical  purposes,  the 
sensation  while  the  current  is  passing  through  the  body  steadily 
is  much  less  and  is  often  limited  to  a  sensation  of  burning  at 
the  seat  of  the  electrode.  A  shock  ma}'  also  (thirdl}')  be  pro- 
duced by  a  reversal  of  the  current,  and  the  shock  thus  caused  is 
stronger  for  the  same  current  than  that  produced  in  either  of 
the  other  ways. 

The  strength  of  these  shocks  is  shown  both  by  the  sensa- 
tion produced  and  by  the  amount  of  muscular  contraction 
caused.  When  now  a  shock  is  caused  by  a  continuous  or  con- 
stant current  which  starts  from  an  ordinary  dj^namo  or  other 
electric  generator  or  storer,  it  is  practically  alwaj'S  caused  by 
the  opening  or  closing  of  the  circuit,  or,  what  is  essentialh*  the 
same,  the  diversion  of  a  part  or  the  whole  of  the  current  from 
its  proper  path  to  and  through  some  portion  of  the  human  body 
causes  a  shock  at  the  time  of  the  entrance  of  the  body  into  the 


672  ELECTRICITY — BULLARD. 

circuit  and  another  at  the  time  of  its  exit  therefrom.  Shocks 
from  reversal  of  current  when  such  current  arises  from  a  con- 
stant machine  might  occur,  but  onl}*  through  some  peculiar 
accident.  Hence  the  shocks  (distinguished  from  any  other 
effects  of  electricity)  which  are  received  by  the  person  coming 
into  contact  with  a  constant  current  are  felt  only  at  the  moment 
of  entering  the  circuit  (closure)  and  of  leaving  it  (opening).  If 
a  person  introduces  himself  between  the  two  wires  of  an  elec- 
tric circuit  in  which  a  constant  current  is  used,  in  such  a  man- 
ner as  to  cause  the  current  to  pass  through  his  body,  he  will 
feel  the  shock  only  at  the  moment  when  he  touches  the  second 
wire  and  completes  the  circuit,  and  at  the  moment  when  he 
lets  go  one  of  the  wires  and  opens  the  circuit  (unless  the  current 
be  so  strong  or  be  so  placed  that  he  can  divert  to  himself 
sufiScient  electricity  to  cause  a  shock,  or,  in  other  words,  close 
a  secondary  circuit  in  some  other  way).  While  the  current  is 
passing  throuigh  the  body,  although  it  may  burn  and  cause 
tingling  and  other  unpleasant  symptoms,  there  is  no  proper 
shock.  In  other  words,  an  electric  shock  is  caused  only  by  a 
change  in  the  amount  of  electricity  passing  through  the  body  or 
a  portion  thereof. 

If  we  now  consider  the  effects  of  alternating  currents, 
we  find  that  we  have  another  factor  to  deal  with.  The  general 
principles  are  exactly  the  same,  but  inasmuch  as  the  reversal 
shock  is  stronger  than  the  closure  or  opening  shocks,  other 
things  being  equal,  we  are  likely  to  receive  a  stronger  shock 
from  a  current  of  the  same  force,  and  in  addition  to  this,  as  in 
alternating  machines  the  reversals  occur  with  considerable 
rapidity,  the  person  who  becomes  connected  with  this  circuit 
receives  a  number  of  strong  shocks  within  a  short  space  of  time. 
This  is  a  much  more  serious  matter  than  to  permit  a  current 
of  equal  strength  to  flow  through  the  body  without  change. 

Faradism. — The  effect  of  this  form  of  electricity  on  the 
human  body  is  first  stimulating  and  then  tetanizing  to  the 
muscles.  It  consists  in  a  very  rapidly  interrupted  current,  the 
shocks  being  at  times  so  frequent  that  they  are  not  singly  per- 
ceptible. There  is  probably  also  a  distinct  difference  in  the 
action  of  this  current  from  that  of  the  galvanic  current  aside 
from  its  rapid  interruption.  This  is  not,  however,  of  so  defined 
a  character  as  to  enable  us  at  the  present  time  to  distinguish  in 


FARADISM — STATIC    ELECTRICITY — RESISTANCE.  673 

man  the  results  of  severe  injuries  and  deaths  caused  by  this 
form  from  those  caused  by  other  strong  currents.  Practically 
this  form  of  current  is  but  little  used,  except  in  medical  bat- 
teries and  for  the  purposes  of  experimentation  in  laboratories. 

Static  electricity  has,  so  far  as  we  know,  rarely  or  never 
caused  serious  injuries  or  death.  The  sparks  produced  in  this 
way  have  sometimes  caused  burns,  and  it  is  conceivable  that  a 
strong  electric  current  produced  in  this  way  might  be  danger- 
ous. The  symptoms  could  not  be  distinguished  from  those 
caused  by  other  forms  of  electricity. 

Summary. — The  greatest  source  of  danger  from  electric 
currents  is  the  shock  produced  by  them.  In  ordinary  constant 
or  continuous  currents  this  is  produced  only  at  the  moment  of 
the  opening  and  the  closure  of  the  circuit.  In  alternating  cur- 
rents a  shock  is  also  produced  afc  each  reversal  of  the  machine. 
Faradic  and  static  currents  are  rarely  or  never  used  mechani- 
cally or  in  the  arts.  ♦ 

Resistance. — The  resistance  of  the  human  body  to  electric 
currents  has  been  very  variously  estimated. 

The  reasons  for  these  variations  are:  (1)  that  the  different 
tissues  present  different  resistances ;  (2)  that  the  resistance  in 
the  same  tissue  varies  greatly  under  different  circumstances. 

The  tissue   which  offers  the   greatest   resistance  and   also 

practically  the  greatest  variation  is  the  skin,  or,  more  properly 

speaking,  the  epidermis.     The  resistance  of  this  is  many  times 

as  great  as  that  of  the  rest  of  the  body,  and  when  perfectly 

dry  it  is   impervious   to   currents   of   great   strength.       Witz 

states  that  in  using  a  Ruhmkorf  coil  with  an  estimated  force  of 

250,000  volts  in  Guinea-pigs  and  rabbits,  it  is  advisable  to  cut 

through  the  skin  in  order  to  apply  the  electrodes  directly  to  the 

flesh,  or,  at  least,  to  wet  the  skin  thoroughly,  otherwise  the 

shock  caused  by  the  full  strength  of  the  battery  (six  jars  charged 

from  the  coil)  would  not  cause  death.     Various  animals  offer 

rates  of  resistance  which  vary  somewhat  apparently  according 

to  the  nature  of  the  animal,  but  are  probably  largely  dependent 

on  the  conducting  power  of  its  tissues,  that  is,  of  its  skin.     The 

variations  between  the  resistance  of  similar  animals,  according 

to  the  condition  of  the  skin  at  the  time  of  the  experiment,  are 

much  greater  than  those  which  are  found  between  animals  of 

different  species  under  similar  conditions,  or  which  are  refera- 
43 


674  ELECTRICITY— BULL  ARD. 

ble  to  specific  susceptibility.  Mr.  Harold  P.  Brown  testified  in 
the  Kemmler  case  (Court  of  Appeals,  State  of  New  York — State 
of  New  York  ex  rel.  William  Kemmler  against  Charles  F. 
Durston,  agent  and  warden)  that  he  had  in  the  course  of  his  ex- 
periments seen  a  horse  weighing  1,320  pounds,  with  a  resistance 
of  11,000  ohms,  killed  by  an  alternating  current  at  700  volts. 

The  resistance  of  the  different  cutaneous  surfaces  of  the 
human  body  as  measured  by  Jolly  in  Siemens'  units  was  from 
400,000  down  to  15,000  in  the  male  and  to  8,000  in  the  female 
(Siemens'  unit  is  to  the  ohm  as  1.06  to  1.00). 

Tschirfew  and  Watteville  made  the  resistance  from  80,000 
to  3,000  ohms. 

Experiments  made  at  the  Edison  Phonograph  Factory  and 
Edison  Laboratory  in  July,  1880,  on  259  males  between  the 
ages  of  eleven  and  fifty-one,  showed  a  resistance,  measured 
between  the  hands  immersed  to  the  wrists  in  a  solution  of 
caustic  potash  independent  of  polarization,  averaging  986  ohms 
and  varying  from  1,970  to  550  ohms. 

The  resistance  of  236  men  employed  at  Messrs.  Bergmann 
&  Co.  's  Electrical  Works  in  New  York  appears  to  have  aver- 
aged 1,184  ohms  and  to  have  varied  from  1,870  to  610  ohms. 
These  measurements  were  also  taken  between  the  hands,  which 
were  washed  with  soap  and  water  and  then  dipped  in  jars  con- 
taining a  solution  of  caustic  potash.  The  battery  consisted  of 
four  chromic-acid  cells  each  having  an  E.  M.  F.  of  2  volts. 

As  shown  in  all  the  experiments  on  animals  and  more  espe- 
cially in  the  cases  of  electrocution,  the  continuance  or  duration 
of  the  current  has  much  effect  on  the  resistance.  As  the  cur- 
rent continues  the  resistance  diminishes.  Thus  in  the  case  of 
McElvaine  the  resistance  between  the  immersed  hands  was 
at  the  beginning  800  ohms  and  at  the  end  of  the  contact  of  fifty 
seconds  had  decreased  to  516  ohms.  In  this  case,  when  the 
current  of  1,500  volts  was  applied  from  the  forehead  to  the  leg, 
the  resistance  was  practicallj^  steady  at  only  214  ohms.  Of 
<3ourse  the  small  resistance  in  these  cases  (electrocutions)  de- 
pends largely  on  the  perfect  contact  secured. 

According  to  the  amount  of  resistance  offered  do  the  effects 
of  severe  shocks  of  electricitj^  differ.  This  is  shown  especially 
well  in  the  action  of  lightning,  but  is  also  true  of  powerful 
currents  produced  mechanically.     If  the  resistance  of  the  skin 


RESISTANCE — MECHANICAL   EFFECTS.  G75 

be  slight  at  the  moment  of  entering  the  circuit  of  a  strong 
current,  the  current  will  pass  through  it  with  comparative  ease 
and  without  causing  much  injury ;  but  if  on  the  other  hand  the 
resistance  is  great,  the  current  will  be,  as  it  were,  momentarily 
retarded  or  stored,  heat  will  be  developed,  and  there  will  ensue 
a  burning  and  charring  of  the  tissue  of  a  special  kind.  These 
burns  occur  principally  at  the  places  where  the  current  is  spe- 
cially resisted,  that  is,  at  the  point  of  entrance  of  the  current  to 
the  bod}"  and  at  its  point  of  exit.  This  is  the  cause  of  the  fre- 
quent burns  in  the  heel  or  sole  of  the  foot  in  the  case  of  those 
struck  by  lightning  while  standing,  as  the  electricity  passes 
away  from  the  body  into  the  ground  and  finds  a  strong  resist- 
ance at  the  point  of  leaving  the  body.  This  is  also  the  cause 
of  the  burns  where  the  current  leaves  the  body  from  any  other 
cause,  as  from  the  contact  or  proximit}'  of  a  metallic  object. 
The  greater  the  resistance  so  long  as  the  current  passes,  other 
things  being  equal,  the  more  severe  is  the  burn.  It  is  for  this 
reason  that  in  medical  electricity  we  usually  use  wet  sponges 
on  the  skin  or  electrodes  moistened  with  salt  and  water  or 
with  other  fluids  which  will  assist  in  rendering  the  passage  of 
the  electricity  through  the  skin  more  easy.  Solutions  of  chlo- 
rid  of  sodium  and  of  certain  other  salts  do  this. 

The  mechanical  eflfects  of  currents  vary  thus  according 
to  the  resistance  encountered.  They  also  vary  according  to  the 
intensit}^  or  concentration  of  the  current.  If  a  current  of  mod- 
erate force  be  applied  through  a  small  metallic  point,  it  will 
burn,  pain,  and  produce  active  irritative  symptoms,  while  if 
the  same  amount  be  applied  over  a  large  surface  simultaneously, 
it  may  have  little  or  no  irritating  eflFect.  We  have,  therefore, 
three  factors  in  determining  the  mechanical  effect  of  any  elec- 
tric current  on  the  body:  (1)  the  condition  of  the  body,  that  is, 
the  amount  of  resistance  which  the  current  will  encounter  at 
its  entrance  and  exit;  (2)  the  amount  and  intensity  of  the 
current;  and  (3)  the  character  of  the  current.  For  practical 
purposes  of  the  more  severe  currents  we  have  only  to  deal  with 
the  continuous  and  alternating. 


676  electricity — bullard. 

symptoms. 
Direct  Symptoms. 

The  direct  symptoms  produced  by  powerful  mechanical  cur- 
rents of  electricity  may  be  divided  into  three  classes :  I.  The 
mechanical;  II.  The  essential  or  internal ;  III.  The  mental  or 
psychical. 

These  classes  are  fairly  distinct,  but  they  are  not  absolute, 
and  certain  symptoms  are  on  the  borders. 

The  most  important  mechanical  symptoms  produced  by 
these  currents  are  burns.  These  occur  at  all  points  of  strong 
resistance  externally,  hence  especially  at  the  points  of  entrance 
and  departure  of  the  current.  They  vary  from  all  grades,  from 
the  lightest  possible,  where  only  the  fine  hairs  on  the  skin  are 
singed,  to  those  of  extraordinary  depth  and  severity.  The  char- 
acteristic burn  from  powerful  currents  is,  however,  well  distin- 
guished. It  consists  in  a  deep  hole  of  various  shapes  with  clear- 
cut  edges  surrounded  by  an  inflamed  area  and  containing  in  its 
cavity  a  mass  of  blackened  tissue  which  only  separates  from 
the  portions  below  after  several  days,  and  causes  a  wound 
which,  though  not  very  painful,  heals  very  slowly.  The  sever- 
ity of  electric  burns  is  often  at  first  sight  underrated,  and  their 
duration,  when  severe,  is  unexpectedly  long.  It  occasionally 
happens  that  after  a  burn  of  this  character  appears  nearly  healed, 
the  surrounding  and,  in  appearance,  healthy  tissue  breaks 
down,  perhaps  under  a  healthy  skin,  and  a  destructive  process 
occurs  which  much  retards  recovery.  This  is  evidently  due  to 
tissue  destruction  from  a  strong  electric  current  of  such  a  char- 
acter as  to  produce  necrobiosis  without  the  external  appearances 
of  a  burn.  These  burns  are,  perhaps,  oftenest  seen  on  the 
hands,  but  this  is  onl}''  because  these  parts  are  more  likely  to 
come  into  contact  with  the  current.  They  may  occur  in  any 
portion  of  the  body. 

Eyes.— The  injurious  effect  of  electric  light  upon  the  eyes 
has  been  carefuU}^  studied  by  several  competent  observers.  So 
far  as  known  it  has  been  caused  solely  by  the  arc  light.  The 
symptoms  produced  by  exposure  of  the  eyes  for  a  considerable 
period  to  the  electric  light  may  be  slight  or  severe.  In  the 
slighter  cases  we  find  merely  an  acute  conjunctivitis  with  a 


SYMPTOMS.  677 

slight  central  scotoma  which  passes  off  within  twenty-four  to 
forty-eight  hours.  The  symptoms  are  those  usual  in  acute 
conjunctivitis — photophobia,  lachrymation,  sensation  of  a  for- 
eign body  under  the  lids,  discomfort  in  the  eyes,  and  swelling  of 
the  lids.  In  the  more  severe  cases  all  these  symptoms  are  in- 
creased; the  photophobia  and  lachrymation  may  be  intense. 
There  is  sometimes  severe  pain  in  the  supra-orbital  nerve,  and 
occasionally  a  tendenc}'  to  somnolence.  In  these  cases  we  find 
an  intense  conjunctivitis  with  ch3"mosis,  a  central  scotoma 
which  may  render  the  patient  for  the  time  practically  blind, 
and  on  ophthalmoscopic  examination  a  congestion  of  the  ves- 
.sels  of  the  retina  and  choroid,  a  neuro-retinitis,  and  sometimes 
even  hemorrhages  into  the  retina.  There  is  sometimes  peri- 
papillary oedema  and  infiltration  around  the  optic  nerve.  The 
pupil  of  the  eye  in  these  cases  is  usually  much  contracted. 
There  is  sometimes  loss  of  epithelium  from  the  cornea. 

In  certain  severe  cases  there  is  produced  in  addition  to  the 
eye  symptoms  an  erythema  of  the  face.  Bresse  states  that  this 
erythema  can  be  produced  on  the  face,  arm,  or  hand  by  exposure 
to  the  voltaic  arc  at  a  distance  of  thirtj'  to  forty  centimetres. 
The  blush  grows  deeper  for  three  or  four  hours,  then  remains 
stationary  for  a  time,  and  ends  in  desquamation  leaving  a  very 
durable  pigmentation.  The  erythema  is  accompanied  bj'  a  sen- 
sation of  smarting. 

The  strength  of  the  light  and  the  length  of  time  required  to 
produce  these  effects  probably  vary  somewhat  according  to  the 
color  of  the  light.  Emrys  Jones  states  that  he  is  informed  that 
either  excess  or  defect  of  current  gives  a  less  injurious  light 
than  the  normal  current ;  the  excess  gives  a  more  violet,  the 
defect  a  more  orange  light.  On  the  other  hand,  Charcot  con- 
sidered that  the  harmfulness  of  the  electric  light  was  due  at 
any  rate  in  considerable  part  to  the  chemical  or  violet  rays, 
and  Bresse  found  that  when  violet  raj'S  were  added  to  an 
electric  light  as  by  aluminium  it  was  more  injurious  than 
before  to  animals.  What  part  the  brilliancy  of  the  light  plays 
in  determining  the  pathological  results  is  not  yet  fully  settled. 
The  heat,  however,  does  not,  as  a  rule,  seem  to  have  much  effect 
unless  in  extraordinary  instances  where  the  cornea  is  burned. 

Muscular  Contractions. — Another  effect  of  electricitj- 
which  is  externally  visible  on  the  human  system  is  muscular 


G78  ELECTRICITY — BULLAKD. 

contraction.  Slight  muscular  contractions  are  produced  pur- 
posely in  many  cases  in  medical  treatment  therapeutically  or 
for  the  sake  of  diagnosis.  When  the  stimuli  are  sufficiently 
strong  and  follow  each  other  with  great  rapidity,  or  when  a 
strong  continuous  current  is  passed  through  the  muscles,  they 
are  brought  into  a  state  of  continuous  contraction  or  tetanus, 
and  in  this  condition  they  will  remain  for  a  long  period  or 
until  the  electric  stimulus  is  removed.  In  cases  where  a  severe 
electric  shock  is  received  as  from  an  electric  wire,  the  muscles 
which  come  in  contact  with  the  wire  immediately  contract  and 
remain  contracted  while  the  current  continues  to  pass  through 
them.  As  a  result  of  this  we  often  find  that  when  a  severe 
electric  shock  has  been  received  through  the  hands  by  means 
of  a  wire  or  other  conductor  the  sufferer's  hands  are  invol- 
untarily closed  upon  the  wire  or  conductor,  and  cannot  be  un- 
closed by  any  voluntary  effort  until  the  current  is  stopped. 
While  thus  holding  the  conductor  the  hands  are  often  very 
severely  burnt.  Under  these  circumstances  a  strong  force  is 
required  to  remove  a  person  from  a  charged  wire  if  the  current 
be  not  turned  off,  and  it  can  only  be  done  at  a  considerable  risk 
unless  by  those  expert  and  provided  with  special  means. 

Not  only  the  muscles  immediately  in  contact  with  the  con- 
ductor, but  nearly  all  the  voluntary  muscles  of  the  body  may 
be  thus  affected  by  a  powerful  current.  Another  effect  of  this 
involuntary  muscular  contraction  is  the  forcible  muscular  move- 
ments produced  by  the  shock.  As  previously  stated,  when  a 
sufficiently  strong  shock  occurs,  the  voluntary  muscles  of  the 
trunk  and  limbs  may  be  thrown  into  sudden  contraction  in  such 
a  manner  as  to  throw  the  person  violentl}'  and  forcibly  on  to 
the  ground,  or  against  some  object  or  objects  in  the  neighbor- 
hood. In  this  way  one  may  be  propelled  several  feet,  and  many 
varieties  of  surgical  injury  may  be  caused.  Rarely  the  force 
of  the  contraction  is  such  as  of  itself  to  rupture  muscles  or  ten- 
dons, and  it  might  even  fracture  bones  or  dislocate  joints 
already  predisposed. 

Essential  or  Internal  Symptoms. 

We  pass  now  to  what  we  may  consider  the  internal  or  es- 
sential conditions  of  electric  shock,  leaving  the  mental  or  psy- 
chical results  for  examination  later. 


ESSENTIAL   OR   INTERNAL   SYMPTOMS.  679 

When  a  person  receives  a  severe  electric  shock,  the  symp- 
toms are  usually  as  follows :  In  the  first  place  there  may  be 
little  or  nothing  except  a  burn  or  burns,  though  usually  there 
is  some  sensation  at  the  moment  of  the  shock.  This  may  be  a 
simple  dizziness,  and  is  often  accompanied  by  the  sensation  of 
a  brilliant  flash  of  light  before  the  eyes,  and  sometimes  by  a 
sense  of  impending  danger.  Usually,  however,  there  is  a  loss 
of  consciousness  more  or  less  complete  and  more  or  less  lasting 
according  to  the  severity  of  the  shock  and  the  character  and 
course  of  the  current.  In  the  less  severe  cases  this  gradually 
passes  awaj^  and  in  many  cases  the  patient,  although  weak 
and  feeling  shaken  and  tired,  suffers  no  further  ill  effects  be- 
yond those  of  the  burns  and  mechanical  injuries.  Sometimes 
there  follows  a  general  tremor  which  may  last  a  few  hours  or 
for  days,  and  occasionally  a  clonic  rhythmical  spasm  of  one  or 
more  extremities.  The  loss  of  consciousness  may,  however,  be 
accompanied  or  followed  by  a  condition  of  coUapse,  in  which 
the  pale  face,  profuse  perspiration,  cold  extremities,  and  feeble 
pulse  all  suggest  the  administration  of  stimulants  and  restora- 
tives. As  a  rule,  in  the  stage  of  unconsciousness  the  face  is 
reddened  and  rather  cyanotic.  The  pupils  are  dilated  as  a  ride 
and  the  respiration  stertorous  or  absent ;  the  pulse  may  be  full 
or  feeble,  sometimes  imperceptible  for  a  time.  The  uncon- 
sciousness sometimes  lasts  for  hours,  and  all  means  of  stimula- 
tion, electricity,  artificial  respiration,  rubbing,  have  to  be 
applied  before  the  patient  can  be  restored.  Sometimes  this 
condition  is  succeeded  by  delirium  (Moj^er).  In  a  certain 
number  of  cases  the  shock  is  immediately  fatal,  and  in  others 
the  patients  cannot  be  recalled  from  their  unconsciousness. 

The  secondary  results  of  the  shock,  aside  from  the  injuries, 
may  be  very  slight  or  again  may  be  serious  and  lasting.  They 
are  far  more  apt  to  be  of  the  first  class,  and  when  long  or  con- 
tinued motor  or  sensory  changes  unconnected  with  injuries  fol- 
low, we  are  justified  in  suspecting  mental  or  psychical  phenom- 
ena. One  class  of  secondary  results  is  the  motor.  In  addition 
to  weakness,  unsteadiness  and  tremor  of  the  limbs  and  trunk,  it 
is  not  uncommon  for  the  patient  to  suffer  from  grand  rhythmi- 
cal movements,  at  first,  perhaps,  of  all  extremities,  but  soon 
limited  to  the  extremity  or  extremities  which  were  most  exposed 
or   injured  by  the  current.     We  have  personally  seen   these 


680  ELECTRICITY — BULLARD. 

movements,  and  feel  convinced  that  they  can  be  distinguished 
from  most  of  the  ordinary  forms  of  convulsive  motions  and 
tremors.  The  whole  limb  is  moved  at  once  and  not  separate 
muscles,  and  the  movement  is  a  large,  rhythmical  one,  slow 
and  co-ordinated,  not  at  all  suggestive  of  tremor.  Movements 
of  this  character  are  sometimes  seen  in  so-called  functional  dis- 
ease (hysteria  and  allied  conditions).  They  more  nearly  re- 
semble the  movements  seen  in  some  forms  of  Jacksonian  epi- 
lepsy than  any  others  known  to  me  as  occurring  in  organic 
disease,  but  I  believe  them  in  these  cases  to  be  always  strongly 
suggestive,  if  not  absolutely  significant,  of  functional  affections. 
A  case  reported  by  Dr.  Robert,  of  El  Paso,  well  illustrates  this 
condition.  The  patient,  a  male,  twenty-eight  years  old,  re- 
ceived a  shock  through  a  telephone  wire.  When  seen  first, 
reaction  was  slowly  taking  place,  the  entire  muscular  system 
was  in  clonic  convulsions.  Temperature  97° ;  pulse  rapid  and 
of  low  tension;  respiration  50;  no  cerebral  symptoms.  An 
hour  later  the  movements  were  limited  to  the  left  upper  and  the 
right  lower  extremities,  and  there  was  pain  running  from  the 
region  of  the  spine  down  the  left  arm.  Twenty-four  hours  after 
the  shock,  temperature  99.5°;  respiration  40;  pulse  100.  Had 
slept  well,  but  the  movements  in  the  left  arm  had  never  ceased. 
The  next  day  these  motions  were  limited  to  the  muscles  of  the 
forearm,  and  on  the  fourth  day  they  had  wholly  ceased.  These 
convulsions  consisted  in  extensive  motions  of  the  whole  extrem- 
ity or  of  muscles  or  muscle-groups,  and  not  of  simple  tremor. 
If  the  movements  were  forcibly  controlled,  severe  pain  ensued. 

Next  to  the  motor  symptoms  the  sensory  are  the  most  im- 
portant. Pain  not  infrequently  occurs  after  the  recovery  of 
consciousness  in  the  affected  limb ;  it  is  apt  to  be  sharp,  severe, 
darting  and  neuralgic  in  character.  This  may  last  at  intervals 
for  some  days,  a  dull  ache  occurring  at  first  between  the  inter- 
missions.    It  disappears  of  itself  in  time  without  lasting  effects. 

Hypersesthesia  may  exist  at  first.  Should  this  continue,  or 
if  anaesthesia  not  due  to  secondary  traumatic  conditions  should 
appear  later,  we  should  be  inclined  to  place  these  symptoms  in 
the  third  class. 

Of  other  symptoms  occurring  in  accidents  from  currents  of 
high  potential,  those  which  seem  to  be  due  to  the  direct  action 
of  the  electricity  are  not  serious.     Buzzing  in  the  ears  and  a 


ESSENTIAL   OR   INTERNAL   SYMPTOMS.  G81 

metallic  taste  in  the  mouth  often  occur  at  the  veiy  beginning 
before  the  consciousness  is  involved.  Nausea  and  vomiting 
frequently  occur  later.  There  is  often  considerable  dizziness 
and  vertigo.  Patients  sometimes  complain  of  sensations  as  of 
an  electric  shock  running  through  the  body  which  occur  with- 
out cause  some  hours  or  even  days  after  the  real  shock.  Some 
of  these  sensations  are  certainly  to  be  reckoned  under  the  mental 
or  psychical  symptoms.  Susceptibility  to  the  effects  of  elec- 
tricity, of  lightning,  and  of  thunder-storms,  though  undoubtedly 
in  many  cases  psychical,  has  probably  in  some  cases  an  actual 
foundation.  This  is  certainly  the  casein  lightning  stroke.  On 
the  other  hand,  in  the  large  majority  of  cases  of  electric  acci- 
dents no  such  result  follows,  and  in  many  we  are  expressly  told 
that  such  a  result  was  looked  for  but  not  found. 

The  temperature,  as  affected  by  the  electricity  alone  and  not 
as  secondary  result  of  injuries,  is  not  always  easy  to  determine. 
It  seems  to  be  in  most  cases  lowered  at  first,  being  in  that  of 
Moyer  97.5°  and  in  that  of  Robert  97°.  Later  it  may  rise  to 
a  certain  extent,  usually  to  not  more  than  101°,  but  here  again 
the  influence  of  traumata  is  difficult  to  separate. 

The  pulse  may  be  full  and  soft  or  weak  and  compressible. 
It  is  frequently  very  feeble,  sometimes  almost  imperceptible, 
and  often  rapid.  It  is  apt  to  remain  rapid  and  somewhat  soft 
for  days  in  severe  cases. 

The  respiration  is  at  first  rapid  in  severe  cases  unless  the 
shock  be  so  great  as  to  cause  its  cessation.  This  rapiditj-  re- 
mains for  a  varying  period  and  then  disappears. 

As  a  typical  case  of  the  results  of  shock  from  an  electric 
wire,  we  will  mention  the  one  reported  by  Dr.  F.  W.  Jackson. 
The  patient,  a  man  twenty-two  j^ears  old,  came  in  contact  with 
a  live  electric-light  wire,  touching  it  with  his  hands.  He  was 
thrown  a  distance  of  about  ten  feet  and  then  back  again, 
"swinging  back  and  forth  two  or  three  times."  His  hands 
were  in  contact  with  the  wire  about  three  minutes,  when  the 
current  broke  and  he  fell  to  the  ground  unconscious.  Was 
seen  two  hours  later  by  physician.  Temperature  100° ;  pulse 
100,  strong  and  bounding;  pupils  dilated;  headache;  nervous 
and  irritable;  reflexes  increased.  The  headache  was  accom- 
panied by  insomnia  which  continued  for  three  days,  after  which 
it  disappeared,  and  he  resumed  work  apparently'  none  the  worse 


(J82  ELECTRICITY — BULLARD. 

for  his  accident.  The  pcdmar  surfaces  of  both  hands  and  the 
anterior  surfaces  of  the  forearms  were  blackened  from  the  tips 
of  the  fingers  to  a  point  midway  between  the  wrists  and  the 
elbows,  and  these  parts  were  exceedingly  sensitive  to  the  touch. 
The  least  irritation  of  the  muscles  would  cause  them  to  contract 
violently.  This  condition  ceased  on  the  second  day.  The  cur- 
rent was  from  a  fifty-light  arc  circuit  of  about  2,100  volts;  6.8 
amperes.  The  accident  took  place  out-of-doors  on  a  very  rainy 
night.  The  amount  of  electricity  which  the  patient  received 
was,  as  in  all  such  cases,  very  uncertain. 

FATAL  CURRENT. 

The  amount  of  current  which  will  produce  a  fatal  effect 
varies  with  the  character  of  the  current  and  with  the  points  of 
contact.  Currents  passing  through  the  head  or  those  which 
affect  the  pneumogastric  nerves  are  much  more  dangerous  than 
others  of  the  same  character  and  equal  strength  passing  through 
one  extremity,  for  example. 

The  same  current  will,  of  course,  also  produce  different 
effects,  according  to  the  facility  of  its  conduction  into  and 
through  the  body,  and  this  depends  again  09  the  completeness 
of  the  contact  and  whether  the  bodj^  or  the  portion  thereof 
concerned  enters  directly  into  the  circuit  or  only  forms,  as  it 
were,  a  partial  conductor  and  diverts  a  certain  portion  only  of 
the  current  to  itself.  Again,  the  condition  of  the  epidermis, 
whether  dry  or  wet,  and  the  position  of  the  person  in  relation  to 
good  conductors,  metallic  or  otherwise,  has  much  effect. 

If  the  skin  and  clothes  be  wet,  the  resistance  to  the  current 
is  lessened  and  it  passes  more  readily  into  the  body.  In  the 
same  way,  if  a  person  stands  in  close  relation  to  a  good  con- 
ductor and  places  his  hand  on  one  wire  of  a  high-tension  elec- 
tric circuit,  he  will  receive  a  much  more  severe  shock  than  if 
not  connected  with  such  conductor.  Thus  a  person  standing 
in  a  pool  of  water  (water  is  a  good  conductor),  and  more  strongly 
if  standing  on  the  metallic  rail  of  a  railway  track,  and  touching 
one  wire  of  an  electric  circuit  with  one  hand,  receives  a  much 
stronger  shock  than  if  he  were  standing  on  dry  land,  or  if  his 
boots  were  rubber  or  he  was  otherwise  insulated. 

The  accidents  most  frequent  in  practice  are  those  in  which 


FATAL   CURRENT — ELECTROCUTION.  683 

the  current  has  been  partially  diverted  from  its  original  course 
and  the  person  has  not  entered  fully  into  the  circuit.  In  such 
cases  it  is  not  usually  possible  to  estimate  accurately  or  even 
approximately  the  amount  of  current  which  the  person  has 
received.  No  calculations  can,  therefore,  be  based  on  these 
accidents.  Again,  we  find  that  a  person  may  be  seriously  or 
even  fatally  injured  by  a  current  which  another  person  seems 
to  bear  with  impunity. 

D'Arsonval  in  1887,  in  France,  advised  500  volts  as  the 
maximum  for  the  continuous  current  and  60  volts  as  the  max- 
imum for  the  alternating  current  which  might  be  employed 
without  special  permission. 

Our  only  accurate  knowledge  in  regard  to  fatal  currents 
comes  from  the  experience  derived  from  electrocutions.  From 
these  it  appears  that  an  alternating  current  of  1,500  volts  is 
deadly  if  it  passes  through  the  body  for  more  than  a  few  seconds 
and  if  the  contact  is  perfect. 

Death. — Death  may  ensue  immediately  as  the  result  of  an 
electric  shock  without  any  evident  preliminary  symptoms,  or 
it  may  occur  later,  either  as  the  direct  result  of  the  shock  or  as 
the  consequence  of  the  exhaustion  produced  by  the  burns  and 
other  injuries,  or  directly  from  the  injuries  themselves.  If 
death  does  not  occur  iinmediately  and  if  appropriate  means  of 
aid  are  at  hand,  the  sufferer  usually  survives  and  the  effect  of 
the  electric  shock  gradually  passes  away.  The  danger  after 
this  arises  from  the  burns  and  other  injuries,  and  almost  all  the 
deaths  not  immediate  are  the  results  of  these. 

ELECTROCUTION. 

Electricity  has  been  adopted  in  the  State  of  New  York  as 
the  agent  for  the  execution  of  condemned  criminals.  This  has 
given  rise  to  much  discussion  as  to  what  form  of  current  were 
the  best  adapted  for  this  purpose  and  as  to  what  amount  were 
required  to  produce  death  at  once  and  painlessl3\  These  ques- 
tions may  now  be  regarded  as  practically  settled,  at  least  so 
far  as  regards  the  purposes  mentioned,  and  we  shall  only  refer 
incidentally  to  the  discussions  and  their  results. 

Early  in  1890  a  committee  consisting  of  Dr.  Carlos  F. 
MacDonald,  Dr.  A.  D.  Rockwell,  and  Prof.  L.  H.  Laudy  made 


684  ELECTRICITY — BULLARD, 

a  report  to  the  superintendent  of  prisons  at  Albany  in  regard 
to  the  efficiency  of  the  electrical  appliances  and  dynamos  placed 
in  the  State  prisons  of  Sing  Sing,  Auburn,  and  Clinton.  This 
report  gave  details  of  various  experiments  made  on  animals  to 
determine  the  amount  of  current  and  the  time  required  to  pro- 
duce a  fatal  result. 

On  the  Gth  of  August,  1890,  occurred  the  first  electrocution, 
that  of  William  Kemmler,  alias  John  Hart,  at  Auburn  Prison. 
Dr.  MacDonald  in  his  official  report  to  the  governor  in  relation 
to  this  says :  "  It  is  confidently  believed  that  when  all  the  facts 
in  the  case  are  rightly  understood  the  first  execution  by  elec- 
tricity will  be  regarded  as  a  successful  experiment.  As  might 
have  been  expected  at  the  first  execution  by  this  method,  there 
were  certain  defects  of  a  minor  character  in  the  arrangement 
and  operation  of  the  apparatus.  But  in  spite  of  these  defects 
the  important  fact  remains  that  unconsciousness  was  instantly 
effected  and  death  was  painless." 

The  efficiency,  rapidity,  and  painlessness  of  this  form  of 
execution  have  been  confirmed  by  the  later  experiences.  Up 
to  the  present  date  (May  26th,  1892)  eight  condemned  crimi- 
,nals  have  been  executed  in  the  State  of  New  York.  Apparently" 
all  the  officials  who  are  intrusted  with  the  care  and  inspection 
of  this  subject  seem  satisfied  that  this  is,  on  the  whole,  the 
wisest,  easiest,  and  most  effective  form  of  death  thus  far  prac- 
tised among  civilized  nations.  The  Medico-Legal  Journal  of 
New  York,  in  printing  the  official  report  of  the  recent  executions 
of  four  men  made  by  Drs.  C.  F.  MacDonald  and  S.  B.  Ward 
to  the  warden  of  Sing  Sing  Prison,  states  that  it  furnishes  "  in- 
disputable evidence  of  the  fact  (1)  that  the  deaths  were  painless 
and  the  victims  unconscious  from  the  instant  of  contact;  (2) 
that  they  were  certain  and  unattended  with  any  of  the  revolt- 
ing scenes  so  frequently  witnessed  at  the  scaffold;  (3)  that  the 
method  is  humane  so  far  as  inflicting  physical  pain  or  suffer- 
ing, and  from  all  sides  considered  infinitely  preferable  to  the 
death  by  hanging ;  and  that  so  long  as  capital  punishment  for 
murder  exists  in  New  York,  we  need  not  desire  to  change  the 
method  of  punishment."  These  claims  would  seem  to  be  thus 
far  substantiated. 

The  value  of  this  method  of  execution  is  now  beyond  doubt. 
When  properly  performed  it  is  rapid,  painless,  and  not  repul- 


ELECTROCUTION.  685 

sive.  The  criminal  has  probably  no  physical  sensation  of  pain 
or  discomfort  due  to  the  mode  of  death  from  the  moment  the 
first  shock  occurs.  Since  the  rapidity  of  the  transmission  of 
the  electric  current  through  the  body  is  in  these  cases  much 
greater  than  the  rapidity  of  the  transmission  of  sensation,  it 
seems  just  to  conclude  that  no  sensation  from  the  electricity 
reaches  the  consciousness.  The  only  distress  suffered  by  the 
criminal  is  the  unavoidable  mental  suffering  natural  to  his 
position. 

The  mechanical  means  employed  in  electrocution  are  prac- 
tically the  same  at  Sing  Sing,  Clinton,  and  Auburn  prisons. 
A  special  room  is  provided  for  the  purpose,  which  should  be, 
if  possible,  in  the  basement  with  a  concrete  floor:  this  room 
must  be  of  sufficient  size  to  admit  readily  the  criminal  with  the 
attendant  officers,  the  warden  and  other  officials  in  charge  or  on 
duty  at  the  execution,  and  the  witnesses  for  whom  seats  are 
usually  provided  at  a  little  distance  from  the  criminal's  chair, 
and  also  to  allow  of  plenty  of  room  for  the  management  of  the 
electrical  apparatus,  and  a  good  space  around  the  chair  in  which 
the  criminal  is  placed.  The  electrical  plant  consists  of  an 
alternating-current  dynamo  and  its  accessories,  placed  wher- 
ever may  be  convenient,  according  to  the  arrangements  of 
the  buildings  of  the  institution,  but  connected  by  means  of 
wires  with  the  switch-board  in  the  execution- room.  In  the 
execution-room  also  should  be  the  voltmeter,  the  ammeter,  and 
such  other  instruments  of  measurement  or  precision  as  may  be 
required.  In  charge  of  these  and  of  the  switch-board  during 
the  execution  is  the  electrical  expert,  an  official  paid  by  the 
State  of  New  York.  Means  of  communication  by  electric  bells 
or  otherwise  are,  of  course,  arranged  between  the  execution- 
room  and  the  engineer  in  charge  of  the  dynamo,  so  that  the 
current  can  be  produced  as  desired. 

The  chair  in  which  the  criminal  is  placed  is  made  of  stout 
beams  of  oak  and  is  securely  fastened  to  the  floor  and  insulated. 
It  is  perfectly  plain,  with  broad  arms  and  an  upright  back, 
which  latter  can  be  tilted  backward  a  little  by  means  of  a 
special  arrangement  and  firmly  fixed  in  the  desired  position. 
This  is  accomplished  by  means  of  a  bar  of  wood  which  is  firmly 
attached  at  one  end  to  the  lower  portion  of  the  back  and  runs 
forward  thence  parallel  to  the  seat  of  the  chair  and  alongside  of 


686  ELECTRICITY— BULLARD. 

it ;  to  the  anterior  end  of  this  is  fastened  a  perpendicular  bar 
running  downward,  which  can  be  raised  or  lowered  at  will,  and 
securely  fastened  at  any  height.  As  this  is  raised  or  lowered, 
it  raises  or  lowers  the  anterior  end  of  the  horizontal  beam  and 
correspondingly  lowers  or  raises  the  opposite  end  to  which  the 
back  of  the  chair  is  attached,  thus  moving  the  latter.  When 
the  anterior  end  of  the  horizontal  bar  is  raised  the  posterior 
end  is  lowered  and  the  back  of  the  chair  is  straightened.  At- 
tached to  the  upper  portion  of  the  back  of  the  chair  is  a  head- 
rest, which  can  be  raised  or  lowered  as  desired :  it  may,  as  in 
the  case  of  Kemmler,  have  a  horizontal  arm  which  projects 
forward  and  from  which  the  head-electrode  may  be  suspended. 
The  chair  is  also  furnished  with  broad  leather  straps  firmly 
attached,  two  of  which  pass  around  the  body,  one  around  each 
upper  arm,  one  around  each  lower  arm,  and  one  around  each 
leg.  There  is  also  a  broad  conjoined  or  compound  strap  which 
passes  over  the  head,  encircling  the  forehead  and  the  chin 
and  securing  the  head  firmly  to  the  head-rest.  When  these 
straps  are  properly  adjusted  and  fastened,  any  marked  degree 
of  movement  is  impossible.  The  adjustment  and  fastening  of 
these  straps  can  be  performed  very  rapidlj^,  in  practiced  hands 
taking  not  more  than  forty  seconds. 

The  electrodes  used  have  varied  slightly  in  different  cases. 
In  the  case  of  Kemmler  they  each  consisted  of  a  bell-shaped 
rubber  cup  about  four  inches  in  diameter,  with  a  wooden  handle 
through  which  passed  the  wires  into  the  bell  to  end  in  a  metallic 
disk  about  three  inches  in  diameter,  faced  with  sponge.  The 
upper  electrode  was  so  arranged  as  to  rest  firmly  on  the  top  of 
the  head,  where  it  was  held  closely  by  means  of  a  spiral  spring : 
it  was  attached  to  the  horizontal  arm  of  the  head-rest,  a  sliding 
arrangement  shaped  like  a  figure  4-  The  lower  electrode  was 
in  this  case  attached  to  the  lower  part  of  the  back  of  the  chair, 
and  projected  forward  at  a  level  with  the  hollow  of  the  sacrum. 
There  was  also  connected  with  it  a  sliding  arrangement,  and 
a  spiral  spring  which  in  connection  with  a  broad  strap  around 
the  prisoner's  lower  abdomen  rendered  contact  secure. 

In  the  later  executions  these  electrodes  have  been  somewhat 
modified  and  differently  applied.  The  head-electrode  is  now  so 
formed  as  to  cover  the  forehead  and  temples,  and  can  be  easily 
fastened  in  this  position  without  a  spring.     The  lower  electrodes 


ELECTROCUTION. 


687 


have  been  applied  to  the  leg  in  each  case,  sometimes  apparently 
to  the  calf  and  sometimes  more  to  the  outer  side,  where  they 
are  securely  strapped.  They  are  made  of  such  a  shape  as  to 
cover  a  considerable  portion  of  the  surface  in  this  region.  It 
is  not  a  matter  of  importance  to  which  leg  the  indifferent  elec- 
trode is  attached,  but  they  have  actually  been  applied  in  most 
cases  to  the  right  leg,  though  in  some  they  were  attached  to  the 
left.  They  are  thoroughly  moistened,  usually  with  a  solution 
of  salt  and  water,  and  a  drip  maj-  be  arranged  so  as  to  keep 
them  wet  during  the  passage  of  the  current  or  other  means  em- 
ployed to  this  effect. 

The  electromotive  pressure,  as  shown  by  readings  of  the 
voltmeter  by  Professor  Laudy,  in  the  cases  of  Slocum,  Smiler, 
Hood,  Jugigo,  and  Lopp}',  varied  from  1,458  to  1,716  volts. 
The  ammeter  showed  a  variation  of  from  two  to  seven  amperes. 

The  alternating  current  in  the  case  of  McElvaine  made 
roughly  150  periods  per  second. 

The  number  of  contacts  made  in  each  case  and  the  duration 
of  each  contact  were  as  follows : 


Number  of 
Contacts. 

TIME,   SECONDS. 

1st. 

2d. 

3d. 

4th. 

Kemmler 

Slocum 

Smiler 

Hood 

Jugigo 

2 
2 
4 
3 
3 
4 
2 
4 

17 

27 
10 
20 
15 
15 
50 

70 
26 
10 
20 
15 
11 
36 

10 
20 
15 
15i 

i9 

Loppy 

McElvaine 

m 

Tice 

Total  time,  50. 

In  the  case  of  McElvaine.  the  first  contact  of  fift}^  seconds 
was  made  through  the  hands,  the  second  contact  of  thirty-six 
seconds  from  the  head  to  the  leg.  The  hands  were  immersed 
in  cells  containing  tepid  salt  water,  connected  respectively  witli 
the  opposite  poles  of  the  dynamo.  Kennelly  states  that  in  this 
case,  with  the  hands  immersed  and  the  electromotive  force  at 
1,600  volts,  the  current  began  at  2.0  amperes,  and  in  fift^-  sec- 
onds had  increased  to  3.1  amperes,  indicating  a  resistance  be- 
tween the  electrodes  of  from  800  ohms  at  the  beginning  to  516 


688  ELECTRICITY — BULLARD. 

ohms  at  the  end.  In  the  second  application  from  the  forehead 
to  the  leg  with  an  electromotive  force  of  1,500  volts,  the  current 
amounted  to  7.0  amperes  during  the  thirty-six  seconds  contact, 
indicating  a  resistance  practically  steady  at  214  ohms. 

Alternating  currents  of  from  1,600  to  1,700  volts  and  up- 
ward may  be  considered  fatal  currents,  and  as  capable  of  pro- 
ducing death  when  contact  is  perfect.  Dr.  MacDonald  goes 
so  far  as  to  say :  "  No  human  being  could  survive  the  passage 
through  his  body  of  an  alternating  current  of  more  than  1,500 
volts  for  a  period  of  even  twenty  seconds,  contact  being  perfect. " 

The  physical  phenomena  caused  in  the  body  by  electrocu- 
tion as  at  present  conducted  are  comparatively  simple,  and 
such  as  we  should  logically  expect.  The  instant  the  body  of 
the  patient  enters  into  the  circuit  of  the  current,  all  the  volun- 
tary muscles  appear  to  be  thrown  into  a  condition  of  violent 
contraction  which  continues  so  long  as  the  current  lasts,  and  on 
cessation  of  the  current  is  replaced  by  a  condition  of  extreme 
muscular  relaxation.  All  consciousness  is  apparently  lost  im- 
mediately on  the  application  of  the  current.  This  probably  has 
never  returned  in  any  case,  but  on  the  removal  of  the  body 
from  the  circuit  of  the  current  the  relaxation  of  the  muscles 
causes  movement,  and  sometimes,  as  in  the  case  of  Kemmler, 
slight  spasmodic  movements  of  the  chest  have  occurred.  The 
pupils  in  this  case  were  dilated.  The  condition  of  contraction 
and  rigidity  is  renewed  at  each  new  application  of  the  current, 
to  cease  immediately  when  the  current  is  removed. 

In  Kemmler  chest  movements  and  possibly  heart-beat  oc- 
curred after  the  first  contact,  the  former  perhaps  half  a  minute 
after  the  cessation  of  the  current. 

In  Slocum  there  were  chest  movements  and  radial  pulsation 
after  the  first  contact.  In  Smiler  no  movement  of  the  chest, 
but  radial  pulsation  after  the  third  contact.  In  Jugigo  a  slight 
fluttering  of  the  radial  pulse  when  final  contact  was  broken, 
which  rapidly  ceased.     In  Hood  no  movement  or  pulse-beat. 

In  some  of  the  patients  superficial  burns  have  been  caused 
by  imperfect  contact  of  the  electrodes,  either  on  the  head  or 
at  the  position  of  the  lower  electrode.  In  Kemmler's  case  the 
cerebral  cortex  was  somewhat  affected  under  the  head-electrode. 

The  practical  effect  of  the  application  of  the  current  to  the 
criminal  fastened  in  the  death-chair,  as  seen  by  the  bystander, 


MENTAL   OR   PSYCHICAL   SYMPTOMS.  089 

is  that  immediately  on  its  reaching  him  the  whole  body  is 
straightened  and  rendered  rigid  in  extension,  the  extremities 
tend  to  straighten  out,  and  the  face  may  grow  red  and  turgid. 
There  is  reported  at  times  swelling  and  turgidity  of  the  neck. 
The  whole  body  remains  in  this  tetanic,  stiffened  condition  until 
the  removal  of  the  current,  when  all  the  muscles  relax  and  the 
body  sinks  back  into  the  chair  in  a  state  of  complete  muscular 
collapse. 

MENTAL  OR  PSYCHICAL.  SYMPTOMS. 

The  third  class  of  results  which  are  found  after  electrical 
shocks  from  high-tension  currents  are  the  mental  or  psychical. 
By  the  use  of  these  terms  we  do  not  wish  to  imply  that  they 
are  voluntary.  They  are,  however,  so  far  as  our  present  knowl- 
edge of  pathology  reaches,  largely  functional.  This  is  precisely 
the  class  of  cases  which,  when  resulting  from  railway  accidents, 
are  placed  under  the  head  of  railway-brain  or  railway-spine. 
They  may  be  considered  in  the  present  state  of  our  knowledge 
as  traumatic  functional  neuroses,  though  it  is  probable  that 
when  our  means  of  examination  and  investigation  are  more 
complete  we  may  succeed  in  discovering  a  visible  or  per- 
ceptible lesion.  The  symptoms  affecting  motion  and  sensation 
in  these  cases  are  frequently  accompanied  by  others  of  an  emo- 
tional character,  and  in  many  cases  there  seem  to  be  partially 
or  wholly  voluntary  conditions  and  symptoms  with  the  invol- 
untary. There  is  in  man}^  cases  a  characteristic  loss  or  dimi- 
nution of  the  force  and  power  of  volition,  but  in  others  this  is 
not  perceptible. 

These  conditions  are  so  well  known  when  produced  b}"  other 
causes  that  we  do  not  consider  it  proper  to  enter  into  a  full 
consideration  of  them  here,  but  we  cannot  leave  this  important 
subject  without  a  few  general  remarks. 

No  form  of  affection  or  disease  has  caused  more  discussion 
among  the  medical  profession  or  figured  more  proininently  in 
the  courts  than  this,  and  even  now  there  are  many  questions  in 
relation  to  these  conditions  still  under  dispute.  Our  own  view, 
confirmed  both  by  observation  and  experience,  is  that  the  ten- 
dency in  New  England,  at  least,  has  been  on  the  whole  to  un- 
derrate the  severity,  the  duration,  and  the  amount  of  suffering 

caused  by  these  conditions.     That  because  there  have  been  cases 
44 


690  ELECTRICITY — BULLARD. 

of  malingering,  of  deception,  and  of  rapid  cure  after  the  receipt 
of  damages,  and  because  in  addition  to  this  a  certain  visible 
emotional  and  at  times  apparently  controllable  element  exists, 
the  profession,  and  above  all  the  lait}",  are  led  to  conclude  that 
this  forms  the  essential  condition  and  basis  of  the  disease.  On 
the  contrary,  in  a  very  large  proportion  of  cases  the  symptoms 
are  such  as  cannot  possibly  be  voluntarily  assumed ;  they  pro- 
duce extreme  discomfort  and  often  much  suffering  for  the 
patient,  and  frequently  last  for  years,  rendering  their  victims  in- 
capable of  carrying  on  their  former  occupations. 

Fortunately  in  the  patients  suffering  from  electric  shock 
the  severer  forms  of  these  affections  are  not  so  common.  In 
most  of  the  cases  reported  recovery  has  been  more  or  less  rapid. 
Cases  in  which  previous  hysteria  or  neurasthenia  have  existed 
are  more  liable  to  these  manifestations  than  persons  of  a  pre- 
viously equable  nervous  constitution,  but  these  latter  iire  by  no 
means  wholl}"  exempt.  To  consider  these  conditions,  as  is 
sometimes  done,  as  the  fault  of  the  patient  seems  to  us  both 
unwarrantable  and  unjust. 

LIGHTNING. 

We  now  come  to  the  consideration  of  the  action  of  electric- 
ity in  another  form,  that  of  natural  electricity  or  lightning. 
The  effects  of  this  are  practicall}^  the  same  as  those  of  the  forms 
previously  described,  except  such  differences  as  seem  to  be  fairly 
accounted  for  by  the  vastly  greater  force  of  the  currents  with 
which  we  have  to  deal.  Injuries  and  deaths  from  lightning 
stroke  have  been  recognized  and  described  for  many  centuries, 
and  we  have  now  a  large  collection  of  careful  observations  on 
them.  They  occur  in  most  temperate  regions  with  comparative 
frequency.  In  France  the  number  of  deaths  from  1835  to  1852 
inclusive  (eighteen  years)  was  1,308.  In  England,  including 
Wales,  there  were  in  twenty  years,  1865  to  1884  inclusive,  416 
deaths.  In  1846  Mr.  Eben  Merriam,  of  Brookline,  wrote  to  Mr. 
Arago  that  in  the  three  last  years  about  150  persons  had  been 
killed  by  lightning  in  the  United  States.  In  thirty  years,  from 
1855  to  1884  inclusive,  we  find  101  deaths  in  Massachusetts 
from  this  cause. 

Exposure. — Injuries  and  deaths  from  lightning  maj'  occur 


LIGHTNING.  691 

in  various  places  and  under  various  conditions.  The  severe 
lightning  strokes  are  popularly  supposed  to  occur  only  during 
thunder-storms,  and  in  this  latitude  this  is  undoubtedlj',  as  a 
rule,  true,  but  lightning  strokes  are  reported  to  have  occurred, 
particularly  in  the  South,  from  a  clear  sky,  and  there  seems  no 
reason  to  doubt  that  this  may  happen.  It  is  said  also  that  dan- 
gerous discharges  from  the  earth  to  the  atmosphere  may  take 
place  at  a  considerable  distance  from  an  atmospheric  storm. 
As  a  rule,  the  lightning  is  more  likely  to  strike  some  tall  object, 
as  a  tree  or  a  tower  or  steeple,  and  for  this  reason,  and  to  avoid 
injury  from  falling  branches,  the  shelter  of  trees  should  not  be 
sought  during  thunder-storms  if  lightning  stroke  be  dreaded. 
Ships  at  sea  are  frequently  struck  by  lightning,  partly  perhaps 
on  account  of  the  height  of  the  masts  and  parti}'  on  account  of 
the  metal  in  or  on  them. 

Lightning  obeys  the  same  general  laws  as  the  other  forms 
of  electricity  and  naturally  follows  the  paths  of  least  resistance. 
Persons,  therefore,  who  are  in  the  neighborhood  of  or  in  con- 
tact with  good  conductors  are  in  more  danger  of  injury  by 
lightning  than  when  surrounded  by  or  in  contact  with  poor  con- 
ductors. The  proximity  or  contact  of  a  large  metallic  object 
exposed  in  a  thunder-storm  is  consequently  more  or  less  dan- 
gerous. On  the  other  hand,  the  absence  of  tall  objects  or  of 
specially  good  conductors  of  any  kind  does  not  insure  safety. 
In  many  cases  persons  in  fields  are  struck,  and  cases  are  related 
of  persons  strvick  on  the  prairies  in  the  West.  In  Fredet's  case 
a  shepherd  was  found  dead  in  the  midst  of  the  barren  moors 
(landes)  in  Southern  France. 

More  accidents  appear  to  occur  directly  to  persons  out-of- 
doors  than  to  those  in  houses  or  other  buildings.  When  inside 
buildings,  persons  struck  are  usually  near  an  open  door  or  win- 
dow through  which  the  lightning  enters,  and  they  are  more 
exposed  to  danger  from  this  source  if  there  be  some  metal  ob- 
ject or  good  conductor  in  the  vicinitj".  Persons  carrying  or 
wearing  metallic  objects  render  themselves  thereby  more  liable 
to  be  injured  in  this  way. 

Not  only  does  the  liability  to  injury  from  lightning  vary 
somewhat  according  to  the  exposure  or  position  of  the  person, 
both  in  relation  to  the  free  access  of  the  atmospheric  air  and  to 
the  contact  with  or  neighborhood  of  metallic  objects  or  other 


692  ELECTRICITY — BULLARD. 

good  conductors,  but  also  the  severity  of  the  injuries  may  be 
largely  dependent  upon  what  they  are  wearing  or  carrying  and 
the  condition  of  their  clothing  at  the  time.  If  the  clothing  be 
wet  it  will  act  as  a  good  conductor,  as  will  also  any  metallic 
object  about  the  person.  We  have  already  referred  to  the  action 
of  metallic  objects  upon  the  passage  of  the  electricity  to  and 
from  the  body  and  to  the  condition  of  the  skin  in  relation 
thereto.  The  laws  of  conduction  and  resistance  are  precisely 
the  same  for  the  electricity  of  lightning  as  for  the  other  forms. 
Hence  the  greater  the  resistance  to  the  electricity  at  the  points 
where  it  enters  or  leaves  the  body,  the  deeper  will  be  the  burn. 
Thus  we  find  not  infrequently  that  the  lightning,  in  its  course 
from  the  head  to  the  feet,  meets  with  a  chain  or  a  truss,  and 
almost  iuA^ariably  at  least  a  portion  of  the  current  follows  this, 
causing  a  deep  burn  where  it  again  passes  into  the  skin.  All 
the  external  burns  of  the  lightning,  except  the  initial  one,  are 
determined  by  the  position  and  conditions  of  the  body,  the 
clothing,  and  the  conductors  near.  All  electricity  obeys  the 
same  law  and,  roughly  speaking,  follows  the  path  or  paths  of 
least  resistance. 

The  clothing  w^orn  by  a  person  when  struck  by  lightning 
may  be  acted  upon  in  the  most  various  ways.  Sometimes  it  is 
wholly  stripped  off  the  unfortunate  sufferer,  who,  as  in  a  case 
reported  by  Cook  and  Boulting,  may  have  to  be  protected  with 
sacks  or  other  hastily  improvised  coverings.  In  a  case  re- 
ported by  Nason,  a  girl  of  thirteen  was  struck  while  in  the 
street  and  most  of  her  clothes  stripped  off  and  torn  to  shreds, 
and  the  top  of  her  hat,  which  contained  steel  wires,  was  torn 
from  the  brim.  In  the  case  of  Wilks  the  body  was  stripped 
entirely  naked  and  absolutely  nothing  left  on  except  a  portion 
of  the  left  arm  of  the  man's  flannel  shirt.  The  clothing  is 
sometimes  torn  to  the  finest  shreds,  like  those  of  a  mouse's 
nest,  as  described  by  Van  Horn,  and  in  another  case  (Claes), 
where  the  patient  was  struck  while  on  board  ship,  his  woollen 
jacket  was  torn  into  fine  bits,  which  stuck  to  the  ropes,  and  the 
deck  was  covered  with  fibres  of  wool  as  fine  as  those  of  cotton- 
wool. In  this  case  the  woof  of  the  trousers  was  said  to  have 
been  wholly  destroyed,  while  the  web  was  untouched. 

The  clothing  is  also  often  burnt.  Not  only  are  holes  burnt 
in  it  as  is  usually  the  case  at  the  point  where  the  lightning 


SYMPTOMATOLOGY.  093 

strikes  and  at  the  point  where  it  leaves  the  bodj',  but  it  may- 
be set  on  fire.      It  may  be  found  smoking  or  in  flames. 

Of  all  portions  of  the  clothing  injured,  perhaps  the  coverings 
of  the  feet  are  the  most  frequently  so,  as  the  electricity  is  very 
apt  to  leave  the  body  through  the  feet,  and  the  resistance  op- 
posed is  great.  Hence  the  boot  or  shoe  is  frequently  injured. 
Sometimes  it  is  pierced  as  by  a  bullet,  or  a  large  hole  is  torn  in 
it,  or  it  may  be  torn  to  pieces  or  reduced  almost  to  lint,  while 
the  foot  remains  uninjured.  It  may  be  torn,  shrivelled,  and 
burnt.  In  one  case  the  soles  of  the  shoes  had  disappeared ;  in 
another  the  leg  of  the  boot  was  clearly  divided  from  the  sole 
and  both  straps  were  torn  out ;  while  again  in  another  the  shoe 
was  carried  wholly  off. 

The  amount  of  injury  to  the  clothing  does  not  necessarily 
correspond  to  the  amount  done  to  the  body.  A  person  may  be 
killed  by  lightning  while  the  clothing  is  uninjured.  On  the 
other  hand,  the  clothing  may  be  torn  to  pieces,  carried  away, 
or  even  partially  burnt,  while  the  portion  of  the  body  under- 
neath remains  unhurt. 

Symptomatology, — The  symptoms  of  stroke  by  lightning 
resemble,  in  a  general  way,  those  due  to  high-tension  currents 
of  electricity.  As  in  the  case  of  the  latter,  they  can  be  divided 
into  the  direct,  j^roduced  immediately  by  the  lightning  itself, 
and  the  indirect,  or  secondary,  produced  through  the  medium  of 
other  factors. 

In  the  milder  cases  the  person  struck  feels  dazed  and  be- 
numbed and  may  or  may  not  lose  consciousness  for  a  short 
time.  At  the  moment  struck  they  may  have  the  sensation  of 
a  blow,  and  they  often  see  a  blinding  flash.  On  recovery  of 
their  faculties  there  may  be  a  temporary  anaesthesia  or  weak- 
ness of  one  or  more  extremities,  which  rarely  lasts  more  than 
twenty-four  hours.  There  is  a  general  shock  to  the  system, 
sometimes  slight  loss  of  memory  for  a  time,  and  occasionally 
nausea  and  vomiting.  There  are  often  discolorations  of  the 
skin  of  medium  extent,  and  frequenth'  burns  and  blisters. 
These  persons  have  usually  received  the  stroke  on  one  extrem- 
ity or  have  escaped  the  full  force.  In  the  more  severe  cases 
the  patient  loses  consciousness  immediatel}'  and  may  continue 
unconscious  for  some  hours.  He  passes  into  a  condition  of 
collapse  with  rapid,  feeble  pulse  and  cold  extremities,  and  the 


694  ELECTRICITY — BULLARD. 

pupils  are  dilated.  On  recovery  of  his  senses  the  same  symp- 
toms as  in  the  less  severe  cases,  only  more  pronounced,  are 
found.  The  loss  of  memory  may  be  marked  and  the  intellect 
temporarily  w^eakened,  while  the  weakness  and  anaesthesia  of 
the  extremities  persist  longer.  The  external  injuries,  bums, 
and  wounds  are  liable  to  be  more  severe. 

In  the  fatal  cases  where  death  is  directly  due  to  the  electric- 
ity it  is  usually  instantaneous  or  at  least  without  recovery  of 
consciousness.  It  may  be  caused  by  shock  or  by  apoplexy, 
i.e.,  intracranial  hemorrhage  or  by  the  direct  effect  of  the  elec- 
tricity on  the  brain.  Of  course  death  is  often  due  to  bums  or 
to  indirect  traumatic  injuries. 

The  indirect  traumatic  injuries  caused  by  lightning  are  due 
either  to  the  loss  of  consciousness  of  the  patient,  which  causes 
him  to  fall  and  thus  sustain  injury,  or  to  the  direct  action  of 
the  electricity  upon  him,  knocking  him  down  or  throvdng  him 
to  some  distance,  sometimes  with  great  violence,  or  lastly,  and 
perhaps  the  most  frequent  cause,  to  the  impact  or  pressure  of 
objects  which  are  torn  or  cast  down  by  the  electricity  and  by 
striking  or  falling  on  a  person  produce  great  injury.  Thus 
persons  have  been  killed  by  the  fall  of  buildings,  sheds,  or  trees 
which  were  struck  by  the  lightning,  or  their  branches.  Of 
course  all  kinds  of  traumata  may  be  produced  thus. 

The  direct  external  injuries  caused  by  lightning  are  burns, 
subcutaneous  hemorrhages,  discolorations  and  markings  of  the 
skin  either  dendritic  or  metallic,  lacerations  or  wounds. 

Burns  occur  in  nearly  all,  perhaps  all,  severe  cases  of  light- 
ning stroke.  They  may  be  of  any  or  all  degrees,  and  may  ex- 
tend over  very  small  points  or  over  the  whole  or  nearly  the 
whole  body.  They  may  consist  in  a  simple  singeing  of  the 
hair,  or  they  may  be  very  deep  and  extend  to  the  bone.  As 
before  stated,  the  deep  burns  are  found  at  the  points  of  resist- 
ance to  the  current,  at  its  points  of  entrance  and  exit  from  the 
body,  and,  to  a  lesser  degree,  at  all  points  where  its  course  is 
impeded.  This  occurs  wherever  the  clothes  are  fastened  tightly 
or  pressed  against  the  body,  hence  especially  at  the  neck,  waist, 
knees,  and  sometimes  at  the  ankles.  The  position  of  the  burns 
is  determined,  therefore,  by  the  point  at  which  the  lightning 
strikes  the  person,  the  position  at  the  moment,  and  by  the  ar- 
rangement of  the  dress  and  the  presence  of  metallic  substances. 


WOUNDS — CONTUSIONS.  695 

In  the  large  majority  of  cases  the  upper  portion  of  the  body  is 
the  part  first  touched  by  the  lightning,  and  thence  it  descends 
along  the  body  to  the  ground.  We  are  apt,  therefore,  to  find  a 
severe  burn  about  the  upper  portion  of  the  body,  the  head, 
neck,  or  shoulders ;  then  a  scorching,  singeing,  or  burning,  more 
or  less  severe,  in  the  form  of  a  stripe  or  stripes  more  or  less 
broad  down  the  body :  the  burns  being  deeper  where  the  clothes 
are  tighter  or  where  metallic  objects  come  into  contact  with 
or  are  near  the  body ;  and  finally  a  deep  burn  at  the  nearest  point 
of  contact  with  the  ground,  usually  the  heel  or  some  portion  of 
the  foot. 

The  burns,  however,  vary  greatly.  The  eyes  may  be  burnt 
and  severely  injured  or  destroyed.  The  lightning  has  been 
known  to  enter  the  mouth  and  burn  the  mucous  membrane 
within.  The  deeper  burns  not  infrequently  assume  the  form  of 
holes.  In  Heusner's  cases  about  twenty  whitish-gray  spots, 
varying  from  the  size  of  a  lentil  to  that  of  a  pea,  were  found 
on  the  soles  of  the  feet.  The  hair  is  usually  singed  and  may 
be  burnt  off  in  large  areas,  or  wholly  as  in  a  case  reported  by 
Bernard. 

Wounds. — These  may  be  direct  or  indirect.  We  shall 
speak  here  only  of  the  first.  Like  burns  they  occur  usually  at 
the  points  of  greatest  resistance,  that  is,  the  places  of  entrance 
and  exit,  but  they  may  be  found  in  any  part  of  the  body.  They 
ma}"  be  clean- cut,  as  if  made  by  a  sharp  knife,  or  they  may  be 
lacerated  and  ragged  with  the  edges  contused  or  burnt.  They 
may  consist  of  holes  which  look  as  if  they  had  been  punched 
out. 

Contusions  or  ecchymoses.  These  may  also  be  produced 
directly  by  the  lightning,  and  like  burns  and  wounds  are  most 
apt  to  occur  where  the  resistance  is  greatest.  They  may  be  of 
considerable  importance  in  a  medico-legal  sense,  as  in  Fredet's 
case,  where  there  were  ecchymoses  on  the  neck  similar  to  those 
produced  by  the  fingers  of  a  hand  applied  for  strangulation.  In 
the  case  related  by  Cook  and  Boulting  the  right  side  of  the 
body  appeared  like  an  exaggerated  example  of  post-mortem 
staining.  There  are  sometimes  found  also  dark- brown  spots, 
small  or  large,  which  may  be  soft  and,  when  cut,  containing 
fluid  blood,  or  they  may  be  hard  and  like  parchment,  dr}',  and 
bloodless  on  section. 


696  ELECTRICITY — BULLARD. 

Closely  connected  with  these  are  the  so-called  dendroid  or 
dendritic  marks,  which  are  dark-colored  reddish  bands  or  stripes, 
often  more  or  less  dichotomously  branched,  not  disappearing 
under  pressure,  found  on  the  bodies  of  those  struck  by  light- 
ning. Though  usually  of  the  form  mentioned,  they  may  as- 
sume other  shapes,  as  that  of  an  irregular  star  with  zigzag  rays. 
Balfour  has  figured  an  excellent  example  of  these. 

Metallic  staining  of  the  skin  has  been  known  to  occur 
where  metals  were  in  contact  with  it  at  the  time  of  the  light- 
ning stroke.  These  stains  may  be  permanent  and  are  due  to 
the  introduction  of  the  finely  divided  metal.  Richardson  has 
succeeded  in  producing  this  artificially  in  animals.  He  found 
two  conditions  required,  that  the  metallic  conductor  should  be 
sufficiently  fine  to  offer  resistance  to  the  current  and  that  the 
current  itself  should  be  an  electric  discharge  of  low  tension. 

Loss  of  hair  is  said  to  have  occurred  from  lightning,  though 
the  hair  was  not  burnt.  One  case  has  been  reported  where 
after  a  severe  stroke  all  the  hair  on  the  body  is  said  to  have 
fallen  out. 

Symptoms. 

Under  this  heading  we  shall  consider  only  such  symptoms 
as  are,  so  far  as  can  be  ascertained,  the  direct  result  of  the  elec- 
tricity and  not  those  secondary  to  injuries. 

We  will  consider  first  those  relating  to  the  nervous  system. 

Loss  of  Consciousness. — This  occurs  to  a  greater  or 
less  extent  in  all  but  the  very  mildest  cases.  It  varies  through- 
out all  degrees  from  a  slight  momentary  benumbing  of  the 
faculties  to  the  most  profound  stupor  or  coma.  It  may  then 
last  hours  or  even  days.  On  recovery  the  patient  is  apt  to  have 
some  loss  of  memory,  to  be  dazed  and  confused  for  some  time, 
and  a  certain  obtuseness  or  blunting  of  the  intellectual  faculties 
may  persist  for  a  considerable  period.  This  loss  of  conscious- 
ness is  often  accompanied  by  flushing  of  the  face  and  dilatation 
of  the  pupils,  or  on  the  other  hand  the  patient  may  present  all 
the  symptoms  of  collapse. 

Loss  of  memory  in  regard  to  the  lightning  stroke  after 
recovery  of  consciousness  is  not  rare.  It  is  frequentlj'  complete 
so  far  as  any  recollection  of  the  lightning  goes,  and  there  may 
be  no  remembrance  of  the  thunder-storm.     Sometimes  a  defec- 


SYMPTOMS.  697 

tive  memory  persists  together  with  general  mental  impairment 
(James). 

Mental  Disease. — A  condition  of  mental  impairment  last- 
ing at  least  weeks  or  months  maj^  occur.  Mania  and  the  de- 
lirium of  terror  are  said  to  have  occurred. 

Various  symptoms  of  the  disturbance  of  the  nervous  equi- 
librium are  not  uncommon.  Among  these  we  maj'  mention 
tremor,  insomnia,  and  nervous  dread  of  thunder-storms  and  of 
electricity.  There  is  no  doubt  that  some  persons  who  have 
been  exposed  to  lightning  stroke  do,  at  least  for  a  time,  become 
unusually  susceptible  to  the  influences  of  atmospheric  elec- 
tricit}'. 

Loss  of  Motion — Paralysis. — This  is  a  very  frequent  re- 
sult of  a  stroke  from  lightning.  Hemiplegia  is  not  uncommon. 
In  Bonnet's  case  the  patient  was  struck  on  the  head  by  the 
lightning,  which  caused  a  lacerated  wound  in  the  left  temple, 
but  did  not  injure  the  aponeurosis.  On  recovery  of  conscious- 
ness the  patient  was  found  to  have  a  left  hemiplegia  involving 
the  face  and  both  extremities  accompanied  by  a  diminution  of 
sensation  over  the  left  half  of  the  bodj'.  The  sensation  became 
normal  in  two  days,  but  a  partial  hemiplegia  remained  perma- 
nently. In  the  case  of  Durand  there  was  a  nearl}*  complete 
right  hemiplegia  with  accompanying  hyperaesthesia  and  some 
affection  of  speech.  Deglutition  and  mastication  were  difficult, 
and  there  was  persistent  hiccough.  There  was  photophobia  and 
hyperaesthesia.  The  patient  improved  in  two  weeks  and  finally 
recovered.     There  is  often  a  temporary  hemiplegia. 

Nearly  all  forms  of  paralyses  of  the  extremities  may  occur. 
We  may  have  parah'sis  of  all  the  extremities  or  of  both  arms 
or  legs,  or  monoplegias.  Paraplegia  occurs  not  very  rarelj'. 
It  is  usually  of  short  duration.  It  may  be  accompanied  b}' 
paralysis  of  the  bladder.  Single  muscles  or  muscle  groups  only 
may  be  affected. 

Ptosis  may  occur  with  paralj^sis  of  other  branches  of  the 
third  nerve,  causing  diplopia.  Facial  paralysis  occurs  also 
alone ;  in  one  case  it  lasted  only  twentj'-four  hours,  in  another 
one  month. 

Difficulty  in  mastication  is  sometimes  found,  but  much 
more  frequentl}^  difficulty  in  deglutition  is  reported. 

Retention  of  urine,  dysuria,  or  incontinentia  urinse  may  all 


G98  ELECTRICITY — BULLARD. 

occur,  and  there  is  sometimes  a  paralysis  of  the  rectum,  usually 
temporar}',  and  sometimes  obstinate  constipation,  which  in  one 
case  was  combined  with  paralysis  of  the  bladder  and  mono- 
plegia. 

Aphasia  in  various  degrees  and  various  forms  of  dysphasia 
or  difficulty  in  speech  are  not  uncommon.  They  are  apt  to  be 
temporary. 

Loss  of  co-ordination  in  the  lower  extremities  with  partial 
paralysis  of  bladder  and  rectum  is  reported. 

Convulsions.  — Epilepsy  may  be  brought  on  by  lightning : 
this  would  be  more  likely  to  occur  in  a  person  previously  sub- 
ject to  epileptic  attacks.  Hysterical  convulsions  and  spasms 
may  also  be  produced,  both  immediately  and  as  a  more  remote 
result,  usually  in  persons  predisposed.  Tetany  and  catalepsy 
are  said  to  occur. 

Clonic  spasms  of  the  whole  body  and  convulsive  movements 
of  the  limbs  are  not  very  infrequent.  In  some  cases  a  marked 
sensitiveness  remains  for  a  time  in  the  limbs  struck,  so  that  if 
touched  they  are  immediately  thrown  into  clonic  spasms. 

Disturbances  of  Sensation. — Pam  occurs  in  nearly  all 
cases.  It  is  most  frequently  a  secondary  result  of  the  burns 
and  other  injuries.  Not  rarely,  however,  it  exists  as  a  direct 
symptom  in  the  form  of  a  burning  or  stinging  neuralgia  in  the 
limb  or  limbs  affected.  Sometimes  the  first  sensation  on  the 
recovery  of  consciousness  seems  to  be  pain  all  over  the  body  or 
confined  to  some  portions  only,  but  the  amount  and  character 
of  the  pain,  aside  from  that  produced  by  the  injuries,  varies 
much.  One  patient  had  a  burning  pain  in  the  back  and  leg 
lasting  only  half  an  hour  after  recovery  of  consciousness.  In 
another  case  there  were  pains  all  over  at  the  end  of  the  first 
week.  On  the  whole,  severe  pain  in  some  or  all  of  the  limbs, 
and  less  commonly  in  the  head,  without  paralysis  and  lasting 
some  days  is  not  rare.  In  one  case  reported  by  Paige  the 
patient  had  intense  pain  in  the  head,  neck,  arms,  and  chest; 
that  in  the  head  was  constant,  severe,  and  lasted  seven  days, 
elsewhere  less  constant. 

Pain  in  the  arms  accompanied  b}^  paralysis  and  anaesthesia 
and  lasting  three  months  has  been  reported. 

Headache  is  not  rare  as  a  later  or  secondary  symptom. 

Disturbances  of  sensation  other  than  pain  are  not  rare. 


CONVULSIONS — DISTURBANCES   OF   SENSATION.  699 

A  certain  amount  of  hyperaesthesia  almost  always  exists  in 
the  portion  affected  immediately  after  the  stroke.  This  is  often 
SO  marked  that  it  cannot  be  wholly  due  to  the  burns  or  other 
injuries.  It  is  usually  very  temporary  and  ceases  in  a  few 
hours.  In  some  cases  a  permanent  or  lasting  sensitiveness  to 
the  action  of  electricity  is  said  to  remain. 

Anaesthesia,  loss  or  diminution  of  sensation,  occurs  either 
with  or  without  paralysis.  In  the  cases  reported  by  Balfour, 
one  boy  said  he  could  not  feel  his  legs  and  another  that  his  arms 
were  cut  off.  In  a  case  reported  by  Free  there  was  loss  of  sen- 
sation in  the  right  upper  extremity  from  the  elbow  to  the 
fingers  and  in  the  left  lower  extremity  from  the  knee  to  the 
toes.  As  a  rule,  the  loss  of  sensation  is  temporary  and  quickly 
passes  away,  but  it  may  last,  in  company  with  paralysis,  for 
some  time.  In  such  cases  either  an  organic  lesion  or  a  trau- 
matic neurosis  is  to  be  suspected. 

Parsesthesic©  are  very  common  after  lightning  stroke.  Most 
frequent,  perhaps,  is  the  subjective  sensation  of  numbness. 
Tingling,  formication,  and  the  sense  of  "  pins  and  needles"  may 
occur. 

Beflexes. — As  a  rule,  the  deep  reflexes  seem  to  remain  nor- 
mal. The  superficial  reflexes  of  the  parts  affected  are  at  least 
temporarily  increased. 

Special  Senses. — Sight. — Affections  of  the  eye.  The  eye 
and  the  surrounding  parts  may  be  directly  injured  by  burning. 
We  also  find  many  serious  conditions  caused  by  the  lightning 
the  pathology  of  which  will  be  considered  later.  When  a  person 
is  first  struck  he  may  perceive  a  flash  of  light  or  a  ball  of  fire 
before  losing  consciousness.  While  unconscious  the  pupils  are 
usually  dilated,  but  react.  Sight  may  be  at  once  totally  lost, 
but  this  is  usually  only  temporary.  There  may  be  amblyopia ; 
photophobia,  lachrymation,  and  pain  are  not  uncommon  for  a 
time.  Cataract  may  be  produced  and  other  severe  ocular  affec- 
tions may  result. 

Hearing. — Sudden  and  total  deafness  may  be  caused  by 
lightning,  as  in  the  case  of  Cook,  where  perforation  of  both 
tympana  was  found.  This  may  prove  to  be  only  temporary, 
as  in  the  case  of  Nason,  where  the  patient,  though  totally  deaf 
at  first,  is  reported  as  hearing  fairly  on  the  fifth  daj' ;  on  the 
seventeenth   day,  however,  the  hearing  was  still  dull.     The 


700  ELECTRICITY — BULLARD. 

deafness  may  be  permanent.  With  deafness  tinnitus  is  apt  to 
occur.  Hyperacustia,  or  extreme  sensitiveness  to  noise,  has 
also  been  reported  in  several  cases. 

Smell  and  Taste. — The  person  affected  sometimes  has 
noticed  a  smell  resembling  that  of  sulphur,  and  this  has  also 
been  said  to  have  been  apparent  to  others.  A  metallic  taste 
in  the  mouth  is  not  rare. 

General  Symptoms. — When  first  struck  by  lightning 
and  while  still  unconscious,  the  patient  has  usually  a  flushed 
and  reddened  face,  with  dilated  pupils.  Immediately  follow- 
ing, or  perhaps  without  this  preliminary  stage,  appear  the 
symptoms  of  collapse.  Cyanosis  may  occur,  and  the  patient 
may  appear  to  be  asphyxiated. 

Fever,  not  caused  by  injuries,  ma}'  sometimes  occur,  but 
certainly  not  to  any  extreme  degree.  In  many  cases  the  tem- 
perature when  taken  was  normal,  and  even  in  cases  of  severe 
stroke  without  serious  surgical  injury  the  temperature  has  not 
risen  above  101°.  In  these  latter  cases  it  is  hard  to  say  how 
far  the  temperature  is  affected  by  the  burns  which  are  always 
present. 

The  pulse  is  sometimes  slow,  sometimes  rapid  and  feeble,  or 
almost  imperceptible ;  at  times  it  is  irregular. 

The  respiration  is  apt  to  be  labored.  In  Paige's  case  there 
was  marked  dyspnoea.  It  maj^  be  almost  imperceptible.  It  is 
sometimes  slow  and  sometimes  rapid. 

Nausea  and  vomiting  occur  often  after  recovery  of  con- 
sciousness.    Vertigo  and  reeling  may  exist  from  various  causes. 

It  is  probable  that  seminal  emissions  may  occur  at  the  mo- 
ment of  shock. 

Menstruation,  when  present,  may  be  checked  or  may  con- 
tinue.    Pregnant  women  do  not  necessarily  abort. 

Pathology  and  Pathological  Anatomy. 

A  few  words  must  be  said  in  regard  to  the  pathological 
conditions  which  may  be  directly  produced  by  lightning  and 
can  be  detected  during  life.  The  burns,  wounds,  ecchymoses, 
dendritic  marks,  and  other  external  signs  have  already  been 
fully  considered. 

Certain  pathological  changes,  however,  have  been  found  in 


PATHOLOGY — AUTOPSIES.  7Ui 

the  eyes  which  are  capable  of  being  verified  during  life.  In 
addition  to  swelling  and  oedema  of  the  lids,  to  the'  injuries 
from  burns  and  to  the  various  paralyses  of  the  ocular  muscles, 
changes  in  the  tissues  of  the  eye  itself  may  occur.  In  the  first 
place  we  may  find  corneal  opacities  and  adhesive  iritis.  Irido- 
cyclitis may  occur.  Cataract  formation  is  not  rare,  and  its 
causation  has  given  rise  to  many  theories.  Optic  neuritis  and 
neuro-retinitis  are  sometimes  found;  and  we  have  sometimes 
optic  atrophy.  Structural  changes  in  the  choroid  may  also  be 
caused  by  lightning.  Rupture  of  the  choroid,  hemorrhage 
from  the  choroid  and  retina,  and  partial  detachment  of  the 
retina  may  occur  from  the  shock  without  the  patient  being 
struck  by  the  lightning  and  without  rupture  of  the  external 
tissues. 

Ears. — Perforation  of  the  tympanum  is  reported  in  more 
than  one  case. 

Autopsies. 

We  shall  consider  here  the  pathological  conditions  found  in 
deaths  from  electricity,  whether  due  to  artificial  or  to  atmos- 
pheric sources.  The  results  are  or  may  be  the  same  in  either, 
so  far  as  we  now  know,  and  it  is  probable  that  the  action  of 
the  electricitj^  is  practically  the  same  in  either  case,  onlj'  vary- 
ing as  regards  the  strength  and  tension  of  the  current. 

Rigor  Mortis. — This  has  generally  been  found  in  cases  of 
death  from  artificial  electricity.  In  the  case  of  Jugigo,  who 
was  executed  by  electricity,  it  was  present  four  and  one-half 
hours  after  death.  As  regards  its  occurrence  in  death  by  light- 
ning and  the  rapidity  of  its  onset,  there  has  been  much  discus- 
sion. It  is  certainly  present  in  many  cases,  and  the  probability 
is  there  is  nothing  diagnostic  in  regard  to  it  in  deaths  by  light- 
ning. When  absent,  its  absence  is  probably  due  to  the  pres- 
ence of  some  external  factor  and  has  no  relation  to  the  form  of 
death.  Wo  have,  on  the  other  hand,  no  proof  that  the  rapidity 
of  its  onset  is  increased. 

Coagulation  of  the  Blood. — It  has  been  observed  fre- 
quently that  the  blood  of  persons  struck  by  lightning  does  not 
coagulate  readily.  Sullivan  states  that  in  certain  cases  of  com- 
plete disorganization  after  lightning  shock  the  blood  is  left 
fluid  and  incoagulable  and  its  color  changed  to  a  deep  black. 


703  ELECTRICITY — BULLARD. 

In  one  of  the  cases  of  death  from  artificial  electricity  reported 
by  Grange,  the  heart  was  found  sixty-two  hours  after  death  to 
be  filled  with  liquid  blood  of  a  rosy  vermilion  color,  which 
quickly  became  darker  on  contact  with  the  air.  A  spectro- 
scopic examination  of  the  blood  showed  the  normal  lines  of 
oxidized  blood  reducible  by  sulphydrate  of  ammonium.  In  a 
case  reported  by  Matzinger  the  blood  as  submitted  was  black 
and  perfectly  fluid,  the  corpuscles,  both  red  and  white,  were 
normal,  and  no  fibrin  was  detected.  In  those  executed  by  elec- 
tricity the  blood  seems  to  have  been  fluid  and  not  in  any  way 
remarkable. 

There  seems  to  be  no  evidence  that  the  bodies  of  those  dying 
from  electricity  in  any  form  suffer  unusually  rapid  decompo- 
sition. 

The  only  absolute  sign  of  death  from  electricity  is  decompo- 
sition of  the  tissues,  but  the  usual  signs  are  to  be  relied  upon  to 
the  same  extent  as  in  ordinary  cases  of  death. 

Internal  Organs. — In  the  cases  of  death  from  mechanical 
electricity  no  changes  in  the  internal  organs  other  than  those 
due  to  accidental  traumata  have  been  found,  except  a  consider- 
able degree  of  congestion  and  sometimes  minute  hemorrhages 
in  the  heart  substance  beneath  the  pericardium  and  into  the 
pulmonary  air-vesicles  and  pleura.  In  one  of  Grange's  cases 
the  heart  was  filled  with  liquid  blood ;  in  the  other  it  was  com- 
pletelj'  empty,  the  right  ventricle  collapsed,  the  walls  of  the  left 
ventricle  hard  and  contracted. 

Careful  autopsies  were  made  in  the  cases  of  the  criminals 
executed  by  electricity,  but  no  important  changes  caused  by 
the  electric  current  have  been  detected  either  macroscopically  or 
microscopically.  A  few  petechial  spots  (Tardieu's  spots)  are 
apt  to  be  found  underneath  the  pericardium  in  the  heart  tissue 
and  sometimes  beneath  the  pleura.  The  organs  were  not  ex- 
tremely congested.  In  the  case  of  Jugigo  the  vessels  of  the 
spinal  cord  and  its  membranes  contained  if  anything  less  blood 
than  usual.  In  this  case  the  amount  of  blood  found  in  the 
brain  seems  to  have  been  about  normal,  the  vessels  of  the  dura 
were  moderately  dilated  and  those  of  the  pia  "  in  a  medium 
state  of  congestion."  In  the  case  of  Kemmler  the  portion  of 
the  intracranial  contents  underneath  the  head-electrode  was 
somewhat  affected  directly  by  the  heat,  the  meningeal  vessels 


INTERNAL    ORGANS.  703 

in  the  dura  were  carbonized,  and  the  brain  cortex  was  sensibly 
hardened  to  one-sixth  of  its  depth,  "where  there  was  a  broken 
line  of  vascularity. "  The  post-mortem  temperature  in  this  case 
seems  to  have  remained  unusually  high,  being  97°  F.  in  the 
fourth  ventricle  and  99°  F.  at  the  back  of  the  neck  three  hours 
after  death  in  a  room  where  the  temperature  was  onh'  83°. 

In  autopsies  after  death  by  lightning  the  results  are  in  gen- 
eral analogous.  The  brain  and  its  membranes  may  be  anaemic 
or  congested.  Effusions  of  blood  may  be  found  beneath  the 
dura  or  in  the  brain  substance  itself,  due  to  the  laceration  or 
injury  of  vessels.  Rupture  of  the  brain  is  said  to  have  oc- 
curred, and  Phayre  reports  a  case  in  which  the  left  hemisphere 
was  entirely  destroyed  and  changed  into  a  dark  gray  homoge- 
neous fluid  mass,  only  a  small  portion  of  the  corpus  callosum  re- 
maining. No  extravasation  of  blood,  laceration  of  the  vessels 
or  membranes,  or  injury  of  the  bones  was  detected. 

Ecchymotic  spots  are  frequently  found  beneath  the  serous 
membranes,  pericardium,  pleura,  and  peritoneum. 

Schmitz  states  that  parenchymatous  inflammation  of  the  in- 
ternal organs  may  occur,  and  Sullivan  reports  a  case  where 
the  stomach  was  found  to  be  gangrenous  over  a  large  sur- 
face, the  patient  having  lived  several  days.  Cases  of  rupture  of 
the  heart,  the  liver,  and  the  spleen  are  reported. 


THE  MEDICO-LEGAL  CONSIDERATIO]^ 


OF 


Death  by  Mechanical  suffocation 


INCLUDING 


HANGING   AND   STRANGULATION. 


BY 

DANIEL   SMITH   LAMB,  A.M.,  M.D., 

Pathologist  Army  Medical  Museum,  Washington,  D.C.;  Professor  of  Anatomy  Medical 
Department  Hoivard  University,  Washington;   Secretary  Association  of  Ameri- 
can Anatomists;  Late  Acting  Assistant  Surgeon  United  States  Army; 
President  of  Association  of  Acting  Assistant  Surgeoiis 
U.  S.  A. ;  Member  of  Learned  Societies. 


MECHANICAL  SUFFOCATION. 

Suffocation  is  the  name  applied  to  both  the  act  of  and  con- 
dition resulting  from  the  deprivation  of  atmospheric  air.  If 
the  deprivation  is  due  to   mechanical   interference,  the   term 

MECHANICAL   SUFFOCATION  is  USed. 

Mechanical  interference  may  be  by  pressure  upon  or  obstruc- 
tion within  some  portion  of  the  respiratory  tract.'  Suffocation 
by  pressure  upon  the  neck  is  called  hanging  when  the  con- 
stricting force  is  the  weight  of  the  bodj^  itself ;  and  strangula- 
tion in  all  other  cases.  German  writers  designate  strangula- 
tion by  cords,  ropes,  and  the  like  as  Erdrosselung,  and  by  the 
hand  as  Erwiirgungj  French  writers  do  not  make  this  distinc- 
tion. In  English  the  word  throttling  is  probably  oftener 
applied  to  strangulation  by  the  hand  than  by  cords. 

The  term  suffocation  is  also  applied  in  a  special  sense 
to  the  act  and  result  of  pressure  on  the  mouth,  nose,  or  chest 
and  abdomen,  stopi^ing  the  breathing;  or  of  obstruction  within 
the  respiratory  tract;  or  of  pressure  upon  the  tract  from  the 
oesophagus,  etc. ;  or  of  breathing  of  irrespirable  gases. 

Strangulation  is  almost  always  homicidal,  hanging  almost 
always  suicidal,  and  suffocation  (limited)  usually  accidental, 
but  also  often  homicidal. 

Strangulation  may  be  admitted,  therefore,  as  including  all 
cases  of  suffocation  by  pressure  on  the  neck,  whether  by  cords 
or  the  hand ;  but  excluding  hanging. 

It  will  facilitate  the  study  of  the  subject  if  we  use  the  word 
ligature  as  a  general  term  to  cover  the  many  forms  of  cords, 
ropes,  etc.,  used  in  strangulation  and  hanging. 

The  word  garroting  is  often  used  to  indicate  the  forcible 
compression  of  the  neck  b}'-  the  hands  of  thieves.  The  assault 
is  usually  made  from  behind,  and  the  victim  is  robbed  while 
the  throttling  proceeds.  The  brevity  of  the  process  explains 
why  death  is  not  more  frequent.  The  word  garroting  comes 
from  the  Spanish;  criminal  execution  in  Spain  and  Italy  is 


708  STRANGULATION — LAMB. 

usually  by  means  of  the  garrote,  a  steel  collar  which  is  tight- 
ened on  the  neck  of  the  condemned  b}'  a  screw.  The  notorious 
thugs  of  the  East  Indies  used  sometimes  a  soft  loin-cloth,  at 
others  a  lasso  or  long  thong  with  a  running  noose.  In  Turkey 
and  some  other  Eastern  countries  the  bowstring  is  a  common 
mode  of  execution. 

An  examination  of  the  reported  cases  of  strangulation  and 
hanging  shows  a  great  variety  of  forms  of  ligature:  cords, 
ropes,  thread,  thongs,  lassos,  flexible  twigs,  bamboos,  leather 
straps,  girdles,  turbans,  fishing-nets,  collars,  cravats  and  other 
foims  of  neckwear,  bonnet  strings,  handkerchiefs,  sheets,  etc. 
Women  have  even  strangled  themselves  with  their  own  hair 
(Case  34).  Stones,  sticks,  coal,  and  other  hard  substances 
have  sometimes  been  inserted  in  the  ligature  to  increase  the 
pressure  (Cases  36,  38,  42,  43,  44).  Drunken  and  otherwise 
helpless  persons  have  been  strangled  by  falling  forward  with 
the  neck  against  a  firm  substance. 

strangulation. 
Symptoms  and  Treatment. 

The  symptoms  and  post-mortem  appearances  in  strangula- 
tion will  vary,  according  as  the  deprivation  of  air  is  sudden  or 
gradual,  partial  or  complete;  and  whether  there  is  coincident 
pressure  on  the  great  arteries,  veins,  and  nerves  of  the  neck. 

The  deprivation  of  air  disposes  to  asphj^xia ;  pressure  on  the 
great  arteries  by  cutting  off  the  supply  of  arterial  blood  to  the 
brain  disposes  to  anaemia  of  the  brain  and  syncope;  pressure 
on  the  great  veins,  b}^  preventing  the  return  of  blood  to  the 
heart,  to  congestion  of  the  brain  and  coma;  pressure  on  the 
great  nerves,  the  pneumogastrics,  to  syncope.  Statistics  of 
hanging  show  that  in  about  seventy  per  cent  of  cases  death  is 
by  a  mixture  of  asphyxia  and  coma.  While  it  is  probable  that 
the  proportion  is  less  in  strangulation,  yet  it  is  also  probable 
that  a  mixed  result  frequenth'  occurs. 

Asphj'xia  is  from  «  priv.  and  fl'cr(3|.'9,  pulse — absence  of  pulse. 

Apnoea  from  a  priv.  and  -v^w,  I  breathe — absence  of  breathing. 

Syncope,  Toyy.o-r^^  a  faint;   suspended   animation  from  sudden 

failure  of  heart.     Coma,  zw,aa,  deep  sleep.     Richardson  '  makes 

'Asclepiad,  1890,  Tii.,  pp.  102-117. 


STRANGULATION.  709 

the  following  distinction  between  asphyxia  and  apnoea:  As- 
phyxia is  difficulty  of  taking  in  breath ;  apnoea  is  breathless- 
ness.  There  is  asphyxia  when  the  blood  from  the  heart  can  go 
to  the  lungs,  but  there  is  no  access  of  air ;  apnoea,  when  there 
is  access  of  air,  but  the  blood  fails  to  reach  the  lungs.  In  as- 
ph3'xia  the  lungs  obstruct  the  circulation ;  in  apnoea  the  obstruc- 
tion is  in  the  heart.  In  asphyxia  the  air  cannot  reach  the  blood ; 
in  apnoea  the  blood  cannot  reach  the  air. 

Quinquaud '  and  Fredericq '  conclude  from  experiments  on 
animals  that  asphyxia  is  due  to  the  deficiency  of  ox5"gen,  not 
to  the  accumulation  of  carbon  dioxide. 

Page  ^  divides  the  phenomena  witnessed  in  an  animal  killed 
by  simply  depriving  it  of  air,  without  interfering  Avith  the 
blood-vessels  of  the  neck,  into  four  stages : 

First.  A  short  stage.  ( In  the  human  subject  this  stage  could 
scarcely  last  longer  than  fifty  seconds,  which  is  said  to  be  the 
extreme  limit  of  the  most  expert  divers.  The  breath  can  be 
held  longest  if  a  number  of  deep  breaths  have  previously  been 
taken,  so  as  to  surcharge  the  blood  with  oxygen.) 

Second.  The  stage  of  "besoin  de  respirer,"  when  the  want 
of  air  begins  to  be  felt ;  the  animal  makes  vigorous  and  violent 
efforts  to  overcome  the  obstacle.  This  stage  may  continue  for 
three  to  four  minutes. 

Third.  Unconsciousness  supervenes  with  irregular  and 
spasmodic  movements ;  efforts  at  respiration  continue. 

Fourth.  Efforts  at  respiration  cease,  but  the  heart  still  beats. 
This  stage  maj^  last  from  two  to  four  minutes.  Hofmann  * 
says  that  it  may  last  a  half -hour.  In  new-born  infants,  as- 
phyxiated, it  may  be  quite  long. 

The  post-mortem  appearances  in  such  an  animal  were  as  follows  : 
the  lungs  were  pale,  reddish,  not  much  distended ;  there  were  a  few 
dilated  air-cells  toward  the  anterior  border ;  hemorrhages  irregularly 
dispersed  over  the  surface  of  the  lung,  varying  in  number  and  size. 
The  right  cavities  of  the  heart  contained  dark  fluid  blood,  the  left  were 
empty.  The  pulmonary  artery  and  systemic  veins,  even  the  smallest 
branches,  were  gorged  with  dark  blood.     Page  adds  that  when   the 

•Compt.  Rendu  See.  Biol.,  1890,  •'"  On  the  Value  of  Certain  Signs, " 

ii  .  pp.  383-387.  etc.,  Edinburgh,  1878. 

-Archiv.    Biol,    de  Gand. ,    1887,  ^  "Lehrbuch  gericht.  Med.,"  1891, 

vii.,  pp.  217-227.  p.  503. 


710  STRANGULATION — LAMB. 

great  vessels  of  the  neck  are  interfered  with  death  may  occur  "bj 
coma,  syncope,  and  even  asthenia." 

CoHn '  made  twenty-five  experiments  on  horses,  and  records  three 
of  them  as  follows :  they  were  all  strangled  with  a  hempen  cord  at 
the  middle  of  the  neck.  The  first  was  quiet  till  the  second  or  third 
minute,  then  there  were  violent  movements  and  strong  efforts  to  dilate 
the  chest ;  at  four  minutes,  spasms  ;  four  and  one-half  minutes,  quiet ; 
six  minutes,  pupils  dilated,  tongue  hanging  out,  limbs  flaccid;  blood 
black.  Second  horse:  Carotid  artery  denuded  to  observe  its  action. 
In  fifteen  seconds,  blood  nearly  black  ;  four  and  one-quarter  minutes, 
no  pulsation  in  carotids ;  five  and  one-half  minutes,  no  respiratory 
movement ;  six  minutes,  heart-beat  ceased,  except  feeble  contraction 
of  auricles,  which  continued  till  twenty-first  minute.  Third  horse : 
In  five  minutes  respiration  ceased ;  tracheotomy  performed,  but  there 
was  no  attempt  to  breathe  ;  eight  minutes,  heart  ceased  to  beat.  Sim- 
ilar results  were  obtained  in  ruminants  and  in  small  animals,  except 
that  the  larger  animals  lived  longer  than  the  smaller. 

Faure  made  the  following  experiment  on  a  large  dog.  He  tied  a 
cord  tightly  round  its  neck ;  for  fifty-five  seconds  it  was  quiet,  then 
suddenly  it  became  agitated,  threw  itself  against  the  wall,  rolled  on  the 
ground,  twisted  itself  ;  bloody  tiucus  escaped  from  the  nose  and  mouth; 
the  teeth  were  ground  together ;  urine  and  faeces  were  passed.  The 
efi'orts  at  respiration  became  very  rapid.  It  fell  dead  at  the  end  of 
three  and  one-half  minutes. 

The  symptoms  of  strangulation  in  the  human  subject  resem- 
ble closely  those  just  described  as  occurring  in  the  dog. 

The  FIRST  or  preliminary  stage  lasts  a  variable  time, 
according  to  the  suddenness  and  completeness  witli  which  the 
access  of  air  is  prevented ;  it  lasts  until  there  is  a  demand  for 
the  air.  In  a  case  of  homicide,  injuries  may  be  inflicted  on 
the  victim  in  this  stage  which  may  have  an  important  bearing  on 
the  cause  of  death.  Blows  on  the  head  may  cause  unconscious- 
ness, or  even  apoplexy;  upon  the  stomach,  may  cause  syncope; 
stab- wounds  may  tend  to  cause  death  from  hemorrhage. 

The  SECOND  stage  begins  with  the  demand  for  air  and  lasts 
till  unconsciousness  supervenes.  It  is  characterized  bj"  frantic 
efforts  to  breathe,  efforts  in  which  the  entire  body  takes  part. 
If  the  subject  is  conscious,  he  is  intensely  so ;  the  expression  of 
the  face  is  intense;  the  eyes  may  protrude,  the  hands  be 
clinched ;  the  memory  is  unusually  active,  and  the  events  of  a 

'Bull.    Acad.    Med.,    1876,  y.,   p.  '  Archiv.   gen.    de  Med.,  1856,  p. 

763.  302. 


STRANGULATION.  711 

lifetime  may  rapidly  pass  before  the  mind  in  a  few  minutes. 
The  tongue  may  be  thrust  between  the  clinched  teeth  and 
bitten ;  and  urine,  faeces,  and  semen  may  be  discharged. 

The  THIRD  STAGE  usually  appears  suddenly,  and  is  charac- 
terized by  unconsciousness  and  irregular  involuntary  move- 
ments, i.e.,  spasms;  these  may  end  in  opisthotonos;  the  veins 
become  turgid,  and  hemorrhages  may  occur  from  the  eyes, 
nose,  mouth,  throat,  ears,  and  into  the  connective  tissues  of 
the  lungs,  pleura,  pericardium,  etc.  The  circulation  of  venous 
blood  in  the  arteries  is  shown  by  the  general  lividity,  especially 
where  the  skin  is  thin,  as  the  lips  and  tips  of  fingers.  Hof- 
mann  '  states  that  coincident  with  the  oncoming  of  unconscious- 
ness and  convulsions  the  respiratory  effort  becomes  expiratory, 
followed  still  later  by  inspiratory  efforts. 

The  FOURTH  STAGE  begins  with  the  cessation  of  spasms  and 
of  efforts  to  breathe.  The  subject  is  quiet,  but  the  heart  still 
beats.     The  stage  ends  with  the  cessation  of  the  heart-beat. 

Discharges  of  semen,  urine,  and  faeces  may  occur  in  the 
first  and  second  stages,  from  terror;  in  the  second  and  third 
from  the  general  agitation,  and  in  the  third  and  fourth  from 
paralysis. 

Strangulation  according  to  Bernard  ^  causes  a  rise  in  tem- 
perature, varying  from  one  to  two  degrees  (Cent.).  He  thinks 
that  this  is  due  to  the  changes  from  arterial  to  venous  blood, 
especially  in  the  muscles. 

Lukomsky  ^  concluded  from  experiments  that  in  asphj^xia 
both  arterial  and  venous  pressure  is  increased  in  the  systemic 
circulation,  but  diminished  in  the  pulmonary  artery.  The 
highest  degree  of  blood  pressure  coincides  with  the  strongest 
respiratory  movements,  especially  expiration.  He  also  con- 
cluded that  the  Tardieu  spots  (subpleural  ecchymoses)  directly 
depended  on  the  efforts  of  breathing  and  blood  pressure. 

Some  writers,  as  Taylor  and  Tidy,  think  that  death  occurs 
sooner  in  the  human  subject  than  in  the  lower  animals;  where 
the  access  of  air  is  suddenly  and  completely  prevented  death 
may  be  immediate.  Tardieu  says  that  death  follows  pressure 
of  the  hand  sooner  than  that  of  a  ligature. 

'"Lehrb.d.ffer.Med.,"1891,p.  500.         -^Viert.   f.   ger.   Med.,  etc.,  1871, 
^"  Lemons  sur  les  anaesthesiques, "      xv.,  pp.  58-96. 
Paris,  1875,  p.  471. 


712  STRANGULATION— LAMB. 

Fleischmann '  placed  cords  round  his  own  neck  between  hyoid  bone 
and  chin,  tied  them  tightly,  sometimes  at  the  side,  sometimes  at  the 
back,  without  respiration  being  interfered  with,  because  there  was  no 
pressure  on  the  air  passages.  But  his  face  grew  red,  eyes  protruded 
slightly,  there  was  a  feeling  of  great  heat  in  the  head,  of  weight,  com- 
mencing dizziness,  and  suddenly  a  hissing  and  rustling  in  his  ears. 
The  experiment  should  stop  at  this  point.  The  same  symptoms  occurred 
from  applying  the  cord  over  the  larynx.  The  first  experiment  lasted 
two  minutes,  the  second  a  half -minute.  The  difference  was  due  to  the 
different  situation  of  the  cord. 

Dr.  G.  M.  Hammond  -  gives  an  account  of  a  personal  experiment 
in  strangulation.  He  sat  down  ;  a  towel  was  passed  around  his  neck, 
and  the  ends  twisted  together,  making  forcible  compression  of  the 
neck.  At  first  he  had  a  feeling  of  warmth  and  tingling,  first  in  the 
feet,  then  passing  over  the  entire  body ;  vision  partly  lost ;  his  head 
felt  as  if  it  would  burst ;  there  was  confused  roaring  in  ears,  like  the 
sound  heard  on  placing  the  ear  to  a  shell ;  he  x'emained  conscious.  In 
one  minute  twenty  seconds  all  sensibility  was  abolished.  After  a  few 
minutes'  rest  a  second  similar  trial  was  made,  with  similar  results,  ex- 
cept that  sensibility  was  lost  in  fifty -five  seconds.  A  stab  with  a  knife 
drawing  the  blood  caused  no  sensation. 

Should  the  subject  recover  from  the  immediate  effects  of  the 
strangulation  there  may  yet  be  serious  secondary  results. 
Among  these  are  convulsions  and  paralysis ;  extreme  svrelling 
of  face,  neck,  and  chest ;  loss  of  voice ;  lesions  of  larynx  and 
lungs;  abscesses.  Death  may  occur  suddenly  and  remotely 
from  one  of  the  sequelae.  ^ 

In  the  treatment  of  strangulation  the  first  indication  obvi- 
ously is  to  remove  the  pressure  from  the  neck.  Artificial  respi- 
ration will  probably  be  required,  and  may  be  aided  by  ammonia 
applied  to  the  nostrils,  tickling  of  the  fauces,  and  galvanism. 
Colin '  states  that  artificial  respiration  is  useless  after  cessation 
of  heart-beat.  (See  the  treatment  by  galvanism  under  "  Suffo- 
cation.") If  the  body  is  cold,  artificial  heat  by  means  of  hot 
bottles,  etc.  Venesection  may  be  necessary.  Colin  strongly 
advises  venesection  to  relieve  the  distention  of  the  heart.  Stim- 
ulants and  light  food  are  often  required. 

'  Translation    in    Ann.     d'Hvg. ,  Archiv,   1880.   i.,  p.    648);    Petrina 

1832,  viii.,  p.  433.  (Prag.   med.  Woch.,  1880,   No.  39); 

2  Med.  Record,  N.  Y. ,  1883,  xxii. ,  Wagner  ( Jahr.  f .  Psych. ,  1889,  viii. ). 
p.  427.  [Hofmann,    "Lehrbuch,"  pp.    570- 

3  See    Maier   (Friedreich's   Blat.,  573].     See  Cases  17,  19,  31. 

1882,  p.    460);   Moreaud  (Virchow's  -iBuU.  Ac.  Med.,  1876,  v.,  p.  761. 


POST-MORTEM   APPEARANCES.  713 

Limousin  '  recommends  the  use  of  oxygen.  Cobos "  experi- 
mented on  animals  by  injecting  oxygen  hypodermically,  as  a 
means  of  artificial  respiration.  His  conclusions  are  that  the 
oxygen  is  absorbed  and  carbon  dioxide  eliminated  in  the  same 
place.  The  oxygen  thus  introduced  causes  no  trouble.  Tes- 
tevin  ^  cures  asphyxia  by  hypodermic  injection  of  ether. 

The  after-treatment  will  depend  on  the  after-conditions. 

The  prognosis  is  good  if  there  is  no  serious  injury  to  the 
neck  and  treatment  is  promptly  applied. 

PosT-MoRTEM  Appearances. 

The  post-mortem  appearances  in  strangulation  are  ex- 
ternal and  internal. 

The  external  appearances  are  of  two  kinds :  those  directly 
due  to  violence  and  accident  and  those  due  to  asphj^xia. 

External  Appearances  Directly  Due  to  Violence  or 
Accident. — The  marks  on  the  neck.  In  some  fatal  cases 
there  are  either  no  marks  at  all  or  they  are  but  slight;  this  is 
more  likely  to  be  the  case  in  suicides  than  homicides,  and  is 
usually  due  to  the  ligature  being  soft  and  yielding.  The  vic- 
tim of  a  homicide  may,  however,  first  be  stunned  and  after- 
ward strangled. 

Marks  are  said  to  be  plainer  after  the  body  has  become  cold 
and  where  subjects  have  recovered  from  attempts  at  suicide. 

The  marks  of  the  ligature  in  strangulation  usuall}^  encircle 
the  neck  more  completely  and  more  horizontally  than  in  hang- 
ing. These  conditions  may,  however,  be  reversed,  because  a 
body  maj^be  dragged  by  the  neck  after  strangulation,  and  there 
have  been  suicides  by  hanging  in  whom  the  mark  of  the  cord 
was  horizontal.  As  a  rule,  however,  a  horizontal  mark  with 
the  knot  on  the  same  level  as  the  cord,  especially  if  below  the 
larynx,  suggests  strangulation  rather  than  hanging;  and  if 
there  are  several  marks  the  probability  is  even  greater.  In 
compression  with  the  fingers  the  marks  are  not  in  a  horizontal 
but  oblique  line. 

The  mark  of  the  ligature  is  usually  circular,  well  defined, 

'Ass.  Fran?.  Av.  Sci.  (1883),  1884,  « Rev.  d'Hyg.  ther.,  1890.  ii.,  pp. 

xii.,  pp.  1042-1045.  67-72  and  131-137. 

3  Alger.  Med.,  1887, xv.,  pp.  78-90. 


714  STRANGULATION — LAMB. 

and  corresponds  closeh'  to  the  breadth  of  the  ligature;  rather 
depressed,  and  usually  below  the  larynx.  As  a  rule  this  de- 
pression is  not  deep ;  the  skin  at  the  bottom  of  the  groove  is 
usually  very  pale,  while  the  adjacent  parts  are  red  or  livid. 
Sometimes  the  bottom  of  the  groove  shows  ecchymoses.  Ney- 
ding  *  says  that  suggillations  in  the  groove  made  by  the  ligature 
on  the  neck  are  rare,  but  are  oftener  found  in  strangulation 
than  hanging,  because  the  conditions  favoring  their  formation 
are  oftener  found  in  strangulation.  In  most  cases  the  skin  and 
connective  tissue  of  the  groove  and  of  the  parts  in  the  vicinity 
show,  microscopically,  hypersemias  and  hemorrhages.  Liman " 
states  that  when  we  find  suggillation  in  the  groove  or  its  vicin- 
ity, we  may  know  that  some  other  form  of  violence  has  been 
applied  at  the  same  time  as  that  of  the  ligature  or  hand.  He 
had  not  seen  suggillation  in  the  furrow  either  in  strangulation 
or  in  hanging,  except  when  the  injured  persons  had  lived  some 
time,  and  in  cases  of  twisting  of  the  umbilical  cord.  The  ab- 
sence of  suggillation  and  ecchymosis  was  due,  he  thought,  to 
the  pressure  on  the  capillaries.  Bremme  ^  saj^s  that  in  the  sub- 
cutaneous connective  tissue  of  the  mark  of  the  ligature  there  is 
no  hemorrhage  either  in  strangulation  or  hanging,  if  death 
occurs  at  once  and  the  cord  is  removed  at  once  after  death; 
but  if  the  cord  remains  for  some  time  after  death  there  may  be 
hemorrhage,  or  if  death  does  not  occur  at  once  whether  the  lig- 
ature is  removed  or  not.  It  is  impossible  to  distinguish  ante- 
mortem  from  post-mortem  hemorrhage. 

The  parchment  skin  seen  in  hanging  is  seldom  seen  in 
strangulation.  Ne3'ding  *  says  that  the  dryness  and  induration 
called  parchment  skin  depend  mainly  on  the  amount  of  excori- 
ation of  the  skin,  and  this  is  greater  in  hanging.  Tardieu 
explains  this  frequency  as  being  due  to  the  fact  that  the  con- 
striction in  hanging  lasts  a  longer  time.  Liman  has  seen  the 
parchment  skin  in  those  strangled. 

The  violence  used  may  cause  ecchymoses  and  abrasions  of 
the  skin  of  the  neck  adjacent  to  the  mark  of  the  ligature. 

The  marks  of  very  different  constricting  ligatures  may  be 

'Viert.  ger.  und  ofif.  Med.,   1870,  n^iert.   f.   ger.  Med.,    etc.,   1870, 

xii.,  pp.  340-369.  xiii.,  pp.  247-260. 

*  Ann.  d'Hyg.,  1867,  xxviii.,  pp.  *  Loc.  cit. 
388-402. 


POST-MORTEM   APPEARANCES.  715 

quite  similar.  Taylor '  mentions  a  case  in  which  a  soft  silk 
handkerchief  was  used,  and  the  appearance  was  the  same  as 
that  of  a  narrow  cord,  due  to  the  tightness  with  which  it  was 
tied. 

Where  a  hard  substance  like  a  piece  of  coal  or  stone  is  in- 
serted into  the  ligature,  usually  then  a  soft  cloth,  and  presses 
directly  against  some  part  of  the  neck,  there  is  usually  a  corre- 
sponding bruise. 

Marks  of  pressure  by  the  thumb  and  fingers  are  usually  on 
the  front  of  the  neck,  and  either  just  above  or  below  the  larynx. 
In  many  cases  these  marks  are  only  those  of  the  finger-tips  with 
some  scratches.  These  marks  may  show  definitely  the  proba- 
ble size  of  the  assaulting  hand,  and  whether  right  or  left. 

Marks  of  strangulation  maj^  disappear  rapidly  after  the  re- 
moval of  the  ligature.  Assailants  usually  constrict  the  neck 
much  more  violently  than  is  sufficient  to  cause  death.  Marks 
of  violence  on  the  neck  are,  therefore,  greater  in  strangulation 
than  in  hanging. 

A  great  variety  of  external  injuries  other  than  those  on  the 
neck  have  been  found  in  the  different  cases  reported  where 
other  forms  of  violence  were  used.  With  few  exceptions  such 
additional  injuries  indicate  homicide. 

External  Appearances  Due  to  Asphyxia. — A  few 
of  these  have  already  been  given  under  the  caption  "  Symptoms." 
If  death  occurs  quickly  there  may  not  be  any  signs  of  asphyxia. 
The  general  lividity  which  comes  on  in  the  second  stage  usu- 
ally remains  after  death.  The  face  varies  in  color  from  violet 
to  black  and  ma}"  be  swollen.  Casper''  says  that  the  face  has 
the  appearance  of  any  other  corpse.  Liman  ^  found  the  face 
livid  in  only  one  of  fourteen  cases.  Hofmann^says  that  the 
cyanosis  appears  during  the  agony  because  of  paralysis  of  the 
circulation  and  gravitation  of  blood.  The  cyanosis  of  the  face, 
projection  of  the  eyes,  and  congestion  of  the  conjunctives  are  due 
to  the  expiratory  effort.  These  signs  are  also  seen  in  fat  per- 
sons who  do  not  die  of  strangulation.  Tardieu  ^  mentions  a 
dotted  redness  or  minute  ecchymosis  of  the  conjunctivae   and 

'"Med.   Jur.,"Amer.   ed.,    1892,  -^Ann.  d'Hyg.,  1867,    xxviii.,    p. 

p.  411.  393. 

'  Tidy,  "  Med.  Jur. , "   Amer.   ed. ,  •*  "  Lehrb.  d.  ger.  Med. , "  1891.  p.  504. 

1884,  iii.,  p.  263.  ^  "Pendaison,"  etc.,  1870,  p.  169. 


716  STRANGULATION — LAMB. 

skin  of  face,  neck,  and  chest  as  constant ;  but  this  cannot  be 
considered  characteristic,  because  it  has  been  seen,  though  not 
so  well  marked,  in  death  from  other  causes.  It  has  been  found 
in  suffocation  from  compression  of  the  chest  and  belly;  and 
also  where  there  is  respiratory  interference  in  the  prolonged 
efforts  of  tedious  labor  and  in  convulsions.  Liman '  found  it 
in  those  who  were  hung.  It  is  due,  according  to  Hofmann,"  to 
increased  blood  pressure  and  consequent  hemorrhages.  It  is  of 
importance  as  tending  to  show  that  there  was  stasis  of  blood  in 
the  head  and  face  during  life.  Liman  ^  found  cyanosis  in  the 
conjunctivae,  lips,  back  of  mouth,  and  in  the  muscles.  Maschka  * 
in  234  cases  of  asphj'xia  found  capillary  hemorrhages  of  the 
eyes  and  eyelids  87  times. 

Dastre  and  Morat  ^  claim  that  in  asphyxia  the  cutaneous  cir- 
culation becomes  more  active  than  in  the  normal  state,  while 
at  the  same  time  the  vessels  of  the  abdominal  cavity  are  con- 
tracted. Laffont  *  considers  the  mechanism  of  this  peripheral 
dilatation. 

Post-mortem  stainings  (hypostases)  are  usually  darker 
in  strangulation  than  in  other  forms  of  death.  They  appear 
soon,  as  does  also  putrefaction,  because  of  the  quantity  and 
fluidity  of  the  blood. 

Signs  of  hemorrhage  from  the  nose,  eyes,  and  mouth  maj" 
be  visible;  as  also  bloody  froth  from  the  mouth  and  nose. 
Che  vers '  never  saw  bleeding  from  the  ears  in  strangulation. 
Taylor  *  states  that  Dr.  Geoghegan  informed  him  of  a  case  of 
suicidal  strangulation  by  a  ribbon ;  the  violence  was  great,  there 
was  bleeding  from  the  ear,  and  the  drum  was  found  ruptured. 
In  this  case  the  mark  on  the  neck,  which  was  deep,  nearly  dis- 
appeared after  the  ligature  was  removed.  Taylor  also  saj'S 
Wilde,  of  Dublin,  saw  a  case  of  rupture  of  drum  and  hemorrhage 
in  strangulation.  Pellier*  says  that  Littre  mentions  a  case  of 
rupture  of  tj'mpanic  membrane  in  strangulation  by  a  cord. 
Zoufal  and  Hofmann  have  offered  explanations  of  the  occur- 
rence (Case  35). 

•  Op.  cit. ,  p.  393.  « Compt.   rend.   Soc.  Biol.  (1881), 

'  Op.  cit.,  p.  504.  1882,  iii.,  pp.  1.59-161  and  165-168. 

3  Op.  cit. ,  p.  394.  ■"  Tidy,  op.  cit. 

""Handb.  ger.  Med.,"  1.,  1881,  p.  »"Med.  Jur.,"  Am.  ed.,  1892,  p. 

569.  413. 

5  Compt.  rend.  Soc.  Biol.  (1879),  « Lyon  thesis,  1883,  No.  188,  p.  85. 
1880,  i.,  p.  310. 


EXTERNAL   xVND   INTERNAL  APPEARANCES.  717 

The  FACE  usually  shows  pain  and  suffering ;  although  some- 
times the  features  are  calm.  In  the  latter  case  there  may  have 
been  syncope. 

The  EYES  are  usually  staring,  prominent,  and  congested,  and 
the  pupils  dilated.  Casper '  doubts  their  prominence.  Budin 
and  Coyne  °  state  that  in  asphyxia  the  dilation  of  the  pupil 
progresses  to  a  maximum  and  then  convulsions  occur.  Oph- 
thalmoscopic examination  during  the  dj-spnoea  of  asphyxia 
shows  a  lessened  fulness  of  the  retinal  vessels. 

The  TONGUE  is  often  swollen,  dark,  protruding,  and  some- 
times bitten.  Maschka  ^  states  that  if  the  ligature  lies  above 
the  hyoid  bone,  the  tongue  will  be  drawn  backward ;  if  over  or 
below  the  bone,  the  tip  of  the  tongue  may  appear  more  or  less 
between  the  jaws. 

The  HANDS  are  usually  clinched  and  may  have  in  their 
grasp  articles  which,  under  the  circumstances,  have  a  medico- 
legal value. 

The  EXTERNAL  GENERATIVE  ORGANS  are  Sometimes  con- 
gested ;  erection  of  the  penis  may  have  taken  place  and  per- 
sisted. The  vagina  may  be  moist.  Tardieu,  Devergie,  and 
Casper  *  deny  that  these  appearances  are  usual. 

Involuntary  discharges  of  urine,  faeces,  and  seminal 
fluid  may  have  occurred.  There  is  nothing  characteristic  in 
their  appearance. 

All  the  external  appearances  of  asphyxia  are  usually  more 
marked  in  strangulation  than  in  hanging. 

Internal  Appearances. — The  mark.  Usually  there  is 
hemorrhage  into  the  loose  connective  tissue  under  the  mark  and 
in  the  subjacent  muscles ;  in  most  cases  isolated  and  circum- 
scribed, but  sometimes  extending  be5'ond  the  line  of  the  mark. 
Hemorrhage  from  compression  by  the  fingers  is  more  marked 
than  that  from  ligature.^  Sometimes  there  is  only  fulness  of 
the  subcutaneous  veins. 

The  carotid  arteries  may  suffer  rupture  of  their  inner 
and  middle  coats,  especiallj^  in  atheromatous  subjects  and  when 
the  compression  has  been  great.     Friedberg"  states   that  the 

'  Tidv,  op.  cit.  ^Tardieu,    "Pendaison, "  etc.,   p. 

■Gaz.  Med.  de  Par.,  1875,  xlvi.,  174. 

pp.  90-92.  « Virchow's  Archiv,  1880,  Ixxix., 

^"Handb.  ger.  Med.,"  i.,  p.  571.  p.  409.  and  1878,  Ixxiv.,  p.  401. 
*  Tidy,  op.  cit. 


718  STRANGULATION — LAMB. 

injury  of  the  carotid,  if  there  is  hemorrhage  into  its  middle  and 
internal  coats,  is  a  proof  that  the  strangulation  occurred  during 
life,  and  probably  from  pressure  of  the  fingers  on  the  neck, 
without  any  regard  to  any  disease  of  the  artery.  He  reports 
two  cases.  The  examiner  should  be  careful  not  to  injure  the 
artery  with  his  forceps.     The  vessels  may  contain  clots. 

The  NECK  occasionallj"  suffers  extreme  injur}',  and,  owing 
to  the  violence  used,  this  occurs  oftener  in  strangulation  than  in 
hanging.'     Occasionally  the  neck  is  broken. 

The  HYOID  bone  may  be  fractured  (see  Case  5) .  Maschka  ' 
saw  one  case  in  eighteen  of  Erdrosselung  and  five  cases  in 
fifteen  of  Erwiirgen. 

The  TRACHEA  is  sometimes  torn,  or  may  be  folded  on  itself. 

The  cartilages  of  the  larynx,  especially  if  calcareous,  may 
be  fractured.  This  is  more  likely  to  affect  the  thyroid  than 
cricoid.  The  fracture  would  appear  to  occur  only  as  the  result 
of  enormous  force ;  especially  in  the  young  in  whom  the  car- 
tilages are  so  elastic.  The  experiments  of  Keiller '  on  cadavers 
led  him  to  conclude  that  falls  on  the  larynx,  even  from  a  height 
and  with  superadded  force,  are  unlikely  to  fracture  that  organ ; 
that  severe  pressure  or  violent  blows  against  the  larynx  from 
before  backward  may  cause  fracture;  but  that  severe  lateral 
pressure,  as  in  ordinary  throttling,  is  more  likely  than  other 
forms  of  violence  to  fracture  the  alae  of  the  thyroid  or  even  the 
cricoid  cartilages  and  also  the  hyoid  bone.  Taylor  *  states  that 
Dr.  Inman,  of  Liverpool,  had  informed  him  of  a  case  of  splitting 
of  rings  of  windpipe  from  pressure  (see  Cases  5,  13) .  Maschka  * 
in  fifteen  cases  of  choking  found  six  fractures  of  the  larynx. 

Chailloux®  has  collected  eight  cases  of  fracture  of  larynx  in 
strangulation.  They  were  all  made  with  the  fingers.  The  ex- 
periments of  Cavasse '  seem  to  show  that  there  is  no  great  diffi- 
culty in  fracturing  the  thyroid  in  strangulation. 

Internal  Appearances  Due  to  Asphyxia. — The  veins 
of  the  entire  body  are  distended  with  very  dark  and  very  fluid 
blood,  while  the  arteries,  especially  in  the  young,  are  mostly 
empty.     Experiments  on  the  lower  animals  have  shown  that 

■Tidy,    "Leg.    Med.,"  Am.    ed.,  "» "jyj^jj  j^j..,"  Am.  ed.,    1892,   p. 

iii.,  p.  265.  414. 

-'  "Ger.  Med.,"  i.,  p.  623  and  632.  *  "Ger.  Med.."  i..  p.  632. 

=*Edinb.  Med.  Jour.,  1856.  ii.,  p.  « Paris  thesis,  1874.  No.  291. 

824.  •>  Paris  thesis,  1859,  No.  9. 


INTERNAL   APPEARANCES   DUE   TO   ASPHYXIA.  719 

the  pulmonary  artery  and  systemic  veins  to  the  finest  ramifica- 
tions are  distended  with  dark  blood.' 

The  Heart. — The  right  side,  especially  the  auricle,  is  usu- 
ally full  of  dark  fluid  blood,  due  to  the  mechanical  impediment 
to  the  passage  of  blood  through  the  lungs.  If  the  heart  contin- 
ues to  beat  after  the  respiration  has  ceased  the  right  ventricle  is 
commonly  well  contracted,  like  the  left  cavities,  and  nearly 
empty,  the  lungs  being  much  congested.  Sometimes  the  left 
cavities  of  the  heart  contain  blood.  This  would  be  most  likely 
to  occur  if  the  heart  should  stop  in  the  diastole.  Sometimes 
clots  are  found  in  the  right  ventricle.  Maschka  °  found  clots  in 
the  heart  25  times  in  234  cases  of  asphj'xia. 

The  LUNGS  are  usually  much  congested,  resembling  red 
hepatization,  except  that  the  blood  is  darker.  Hemorrhages 
(apoplexies)  into  the  substance  of  the  lungs  are  common. 
Tardieu  found  patches  of  emphysema  due  to  rupture  of  the 
surface  air-vesicles,  giving  the  surface  of  the  lung  the  appear- 
ance of  a  layer  of  white  false  membrane.  Ogston  admits  this 
occurrence  in  pure  strangulation  but  to  a  less  extent  in  mixed 
cases.  Liman '  found  the  lung  surface  uneven,  bosselated,  the 
prominences  being  of  a  clearer  colof  and  due  to  emphysema. 
The  lungs  were  in  the  same  condition  of  congestion  and  emphy- 
sema in  strangulation,  suffocation,  and  hanging.  He  failed  to 
find  the  apoplexies  described. 

The  lungs  are  sometimes  anaemic.  In  healthy  j^oung  sub- 
jects, especially  children,  the  blood-vessels  of  the  lungs  often 
empty  themselves  after  the  heart  stops.  The  lungs  may,  there- 
fore, be  bloodless,  but  emphysematous  from  the  violent  efforts 
to  breathe.  Page's  experiments  on  the  lower  animals  showed 
the  lungs  of  a  pale  reddish  color  and  not  much  distended ;  a  few 
dilated  air-cells  might  be  seen  toward  their  anterior  borders, 
and  there  might  be  small  hemorrhages  over  the  surface.  His 
experiments  appear  to  show  that  subpleural  ecchj^moses  occur 
as  a  result  of  violent  and  repeated  efforts  to  breathe.  Among 
other  experiments^  he  stopped  the  mouth  and  nostrils  of  a 
young  calf  long  enough  to  excite  violent  efforts  at  respiration ; 
it  was  then  instantly  killed  by  pithing.     The  lungs  were  found 

'Page,  "On  the  Value  of  Certain  ^Tardieu.    "Pendaison, "  etc.,   p. 

Signs, "  etc. ,  Edinburgh,  1873.  178. 

'^  "Ger.  Med.,"  i.,  573.  ■»  Oj).  cit.,  p.  29. 


720  STRANGULATION — LAMB. 

pale  red,  not  congested,  but  showed  subpleural  ecchymoses. 
Page  believed  these  were  due  to  the  changed  relation  between 
the  capacity  of  the  thorax  and  volume  of  lungs.  Liman  found 
these  ecchymoses  in  cases  of  strangulation,  hanging,  drowning, 
poisoning,  hemorrhage,  and  U3dema  of  brain,  in  the  new-born, 
etc.  He  failed  to  find  them  in  some  cases  of  suffocation.  He 
believes  them  due  to  blood  pressure  from  stasis  in  the  blood- 
vessels. Ssabinski '  made  many  experiments  on  dogs  and  cats 
to  ascertain  the  presence  or  absence  of  subpleural  ecchymoses 
in  strangulation,  drowning,  section  of  pneumogastrics,  opening 
of  pleural  sac,  compression  of  chest  and  abdomen,  closure  of 
mouth  and  nose,  burial  in  pulverulent  materials,  etc.  Similar 
hemorrhages  may  appear  on  the  mucous  and  serous  membranes, 
as  the  respiratory,  digestive,  and  genito-urinary  tracts,  and 
pleurae,  pericardium,  peritoneum,  membranes  of  brain,  and  the 
ependyma.  These  are  sometimes  minute  and  stellate,  at  others 
irregular  in  shape;  many  are  bright-colored.  According  to 
Tardieu  the  punctiform  ecchymoses  are  rarely  present  except 
in  suffocation.  Maschka,''  in  234  cases  of  asphyxia,  found 
the  lungs  congested  135  times,  anaemic  10,  and  cedematous 
42.  He  thinks  the  subpleural  ecchymoses  valuable  signs  of 
asphyxia. 

The  BRONCHIAL  TUBES  are  usually  full  of  frothy,  bloody 
mucus,  and  the  mucous  membrane  is  much  congested  and  shows 
abundant  ecchymoses. 

The  lining  membrane  of  the  LARYNX  and  trachea  is  al- 
ways congested  and  may  be  livid ;  the  tube  may  contain  bloody 
froth  or  blood  alOne. 

Tidy  comparing  strangulation  and  hanging  concludes  that 
because  strangulation  is  usually  homicidal,  and  greater  violence 
is  used,  therefore  the  external  marks  are  more  complete  in 
strangulation  and  the  congestion  of  the  air  passages  is  invaria- 
bly much  greater. 

Maschka  found  the  pharynx  cyanotic  in  216  of  234  cases  of 
asph3^xia. 

The  other  mucous  membranes  are  generally  much  con- 
gested.    Serum  is  found  in  the  serous  cavities. 

Maschka '  considers  the  rounded,  pin-head  ecchymoses  of  the 

'  Vier.  f.  ger.  Med.,    etc.,    1867,  '"'Ger.  Med.,"  i.,  p.  576. 

vii.,  pp.  140-174.  'Ih.,  p.  572. 


INTERNAL  APPEARANCES  DUE  TO  ASPHYXIA.      721 

inner  surface  of  the  scalp  and  pericranium  valuable  evidence 
of  asphyxia. 

The  BRAIN  and  membranes  are  sometimes  congested ;  occa- 
sionally apoplectic.  Maschka '  found  congestion  of  brain  and 
membranes  48  times  and  ansemia  30  times  in  234  cases  of  as- 
phyxia. 

The  ABDOMINAL  ORGANS  are  generally  darkly  congested, 
although  Maschka  denies  this  for  the  liver  and  spleen  in  as- 
phyxia. 

The  congestion  of  the  viscera  generally  is  doubtless  due 
largely  to  the  prior  congestion  of  lungs  and  engorgement  of 
heart. 

Page  ^  experimented  on  six  kittens,  strangling  three  of  them  by  the 
hand,  the  other  three  by  ligature.  The  results  of  the  post-mortem  ex- 
aminations were  nearly  similar  :  the  veins  were  full  of  dark  fluid  blood  ; 
the  right  cavities  of  the  heart  were  similarly  gorged,  the  left  empty  ; 
lungs  pale  red,  not  congested  and  not  distended.  Brain  normal.  The 
differences  were  in  the  lungs  ;  in  the  first  series  there  were  many 
small,  irregular,  circumscribed,  dark -red  ecchymoses  scattered  over  the 
general  surface ;  in  the  second,  a  small  number  of  bright-red  ecchy- 
moses, somewhat  larger  than  a  large  pin-head. 

Langreuter^  made  some  experiments  on  a  cadaver  from  which 
enough  of  the  posterior  part  had  been  removed  to  enable  him  to  view 
the  throat.  He  saw  that  the  lateral  digital  pressure  on  the  larynx  closed 
the  glottis  ;  stronger  pressure  made  the  vocal  cords  override  each  other. 
Similar  pressure  between  the  larynx  and  hyoid  bone  caused  apposition 
of  the  ary-epiglottic  folds  and  occlusion  of  the  air-passages.  He  experi- 
mented on  sixteen  bodies  to  ascertain  the  effect  of  blows  and  pressure 
on  the  larynx,  with  the  following  results  :  In  eight  cases,  women,  the 
thja'oid  cartilage  was  injured  three  times,  the  cricoid  four  ;  in  eight, 
men,  the  thyroid  eight  and  cricoid  five.  Whence  he  concluded  that 
the  larynx  is  better  protected  in  women.  In  the  sixteen  cases  the  hyoid 
bone  was  fractured  ten  times. 

The  Proof  of  Death  by  Strangulation. 

Tidy "  says  that  "  nothing  short  of  distinct  external  marks 
would  justify  the  medical  jurist  in  pronouncing  death  to  be  the 
result  of  strangulation."     On  the  other  hand,  Taylor  ^  considers 

•"Ger.  Med.,"  i.,  p.  575.  •»"Leg.  Med.,"  Am.    ed.,  ill.,  p. 

2  "  On  the  Value  of  Certain  Signs, "  267. 

etc.,  Edinburgh,  1878,  p.  24.  6"Med.  Jur.,"Am.   ed.,  1892,    p. 

»Vier.    f.   ger.  Med.,    etc.,    1886,  415. 
xlv.,  p.  295. 

46 


722  STRANGULATION — LAMB. 

the  condition  of  the  lungs  described  as  characteristic.  Liman ' 
did  not  think  there  were  any  internal  appearances  which  could 
distinguish  suffocation,  strangulation,  and  hanging  from  each 
other. 

In  estimating  the  value  of  testimony  it  will  be  well  to  con- 
sider the  following  facts : 

A  victim  may  be  strangled  without  distinct  marks  being 
found.  The  practice  of  the  thugs  shows  that  this  may  be  done 
with  a  soft  cloth  and  carefully  regulated  pressure  without 
making  marks.  Taylor,^  while  admitting  the  possibility,  states 
that  this  admission  "  scarcely  applies  to  those  cases  which  re- 
quire medico-legal  investigation." 

The  subject  while  intoxicated  or  in  an  epileptic  or  hysterical 
paroxysm  may  grasp  his  neck  in  gasping  for  air,  and  leave 
finger-marks. 

Different  constricting  agents  may  make  quite  similar  marks. 
Marks  may  be  made  on  the  neck  within  a  limited  time  after 
death,  similar  to  those  made  during  life.  Tidy's  experiments 
led  him  to  fix  this  limit  at  three  hours  for  ecchymoses  and  six 
hours  for  non-ecchymosed  marks.  Taylor,  Miowever,  doubts  if 
such  marks  could  be  made  one  hour  after  death.  He  says  that 
the  period  cannot  be  stated  positively,  and  probably  varies  ac- 
cording to  the  rapidity  with  which  the  body  cools. 

It  is,  however,  unlikely  in  such  post-mortem  attempts  at 
deception  that  the  other  conditions  usual  in  strangulation  would 
be  found — such  as  lividity  and  swelling  of  face;  prominence 
and  congestion  of  eyes;  protrusion  of  tongue;  rupture  of  sur- 
face air- vesicles  and  apoplexies  in  the  lung;  congestion  of 
larynx  and  trachea,  etc. 

No  conclusion  can  be  drawn  from  the  presence  or  absence  of 
any  single  appearance. 

A  cord  may  be  found  near  a  body  or  even  around  its  neck; 
there  may  even  be  a  mark  around  the  neck.  These  may  be 
attempts  at  deception. 

Marks  much  like  those  of  violence  may  be  made  by  tight 
collars  and  handkerchiefs  remaining  until  the  body  is  cold. 

Cases  are  reported  of  bodies  having  been  first  strangled  and 

1  Ann.  d'Hyg.,  1867,  xxviii.,  pp.  ^ujyjgjj    Jur.,"  Am.  ed.,  1893,   p. 

388-402.  416. 

3  7Z>.,  p.  415. 


THE    PROOF    OF    DEATH    BY    STRANGULATION.  723 

then  burnt  or  hung  to  cover  the  crime ;  and  of  partial  suffoca- 
tion by  gags,  followed  by  or  coincident  with  strangulation  (see 
Cases  18,  20,  24). 

In  apoplectics  with  short  and  full  neck  we  may  find  at  the 
borders  of  the  folds  of  skin  in  the  neck  one  or  more  depressions, 
red  or  livid,  that  bear  some  resemblance  to  the  marks  of  a  liga- 
ture ;  but  on  section  there  are  no  ecchymoses. 

Froth,  tinged  with  blood,  in  the  air-passages  is  considered 
by  Tardieu '  one  of  the  most  constant  signs  of  strangulation. 

The  marks  of  topical  medical  applications,  as  plasters,  sina- 
pisms, etc. ,  must  not  be  confounded  with  marks  of  violence. 

In  strangulation  by  ligature  the  marks  are  usually  hori- 
zontal; in  hanging,  oblique.  In  hanging  too  they  are  usually 
dry  and  parchmenty.  Ecchymoses  are  more  marked  in  stran- 
gulation. 

The  dotted  markings  of  face,  neck,  and  conjunctivae  described 
by  Tardieu  are  more  characteristic  of  strangulation. 

The  principal  distinctions  between  strangulation  and  suffo- 
cation would  be  the  absence  in  the  latter  of  marks  on  the  neck. 

Taylor  ^  quotes  the  case  of  Marguerite  Dixblanc,  in  which 
the  question  was  raised  whether  she  had  strangled  her  mistress, 
Madame  Riel,  or  whether  the  body  had  been  dragged  by  a  rope 
around  the  neck.  The  question  was  left  unsettled  by  the  med- 
ical evidence. 

The  only  motive  for  attempting  to  simulate  strangulation  on 
a  corpse  would  seem  to  be  to  inculpate  an  innocent  person.' 

Both  suicides  and  murderers  are  usually  more  violent  than 
is  necessary  to  destroy  life ;  murderers  more  than  suicides. 

Putrefaction  may  cause  external  marks  to  disappear. 

All  marks  on  a  body  should  be  carefully  noted ;  the  cavities 
of  the  skull,  thorax,  and  abdomen  carefully  examined ;  the  pos- 
sibility of  death  having  occurred  from  other  causes,  even  in 
strangulation,  must  be  considered. 

As  Taylor  well  says,  our  judgment  must  not  be  swayed  to 
the  extent  of  abandoning  what  is  probable  for  what  is  merely 
possible. 

In  all  cases  the  cord  or  strangulating  ligature  should  be 
carefully  examined  for  marks  of  blood,  for  adherent  hair  or 

i"Pend.,"p.  186.  ^  Op.  cit.,  p.  415. 

»  "Med.  Jur.,"  Am.  ed.,  1892,  p.  415. 


724  STRANGULATION — LAMB. 

other  substances.     The  precise  manner  in  which  the  cord  has 
been  tied  should  be  noted. 


Strangulation:  Accidental,  Suicidal,  Homicidal, 
Slmulated. 

The  question  whether  a  case  of  strangulation  is  accidental, 
suicidal,  or  homicidal  is  very  difficult  to  answer. 

Accidental  strangulation  is  rare.  If  the  body  has  not 
been  disturbed,  there  is  usually  no  difficulty  in  arriving  at  a 
conclusion ;  but  if  disturbed  a  satisfactory  conclusion  may  not 
be  reached. 

It  is  worthy  of  mention  that  the  umbilical  cord  may  be 
twisted  around  the  neck  of  a  new-born  infant  and  may  have 
caused  strangulation;  the  mark  may  give  the  appearance  of 
death  by  violence. 

Suicidal  strangulation  is  rare.  The  experiments  of  Fleisch- 
man  (supra)  suggest  that  one  may  commit  suicide  by  compress- 
ing his  throat  with  his  fingers  (see  Case  48). 

Where  a  ligature  of  any  kind  has  been  used  it  is  important 
to  notice  the  number  and  position  of  the  knots.  In  a  general 
way  a  single  knot  either  in  front  or  at  the  back  of  the  neck 
might  suggest  suicide;  more  than  one  would  suggest  homicide. 
There  are,  however,  exceptions. 

Suicide  has  been  committed  by  mere  pressure  of  a  cord  fixed 
at  both  ends  a  shore  distance  from  the  ground ;  by  twisting  a 
rope  several  times  around  the  neck  and  then  tying  it  (the  coils 
may  continue  to  compress  even  after  death) ;  by  tightening  the 
cord  with  a  stick  or  other  firm  substance;  by  tightening  the 
cords  or  knots  by  means  of  the  hands  or  feet  or  some  portion  of 
the  lower  limbs ;  by  the  use  of  a  woollen  garter  passed  twice 
around  the  neck  and  secured  in  front  by  two  simple  knots, 
strongly  tied  one  to  another. 

It  is  difficult  to  simulate  suicide;  requires  great  skill  and 
premeditation  on  the  part  of  a  murderer.  "  The  attitude  of  the 
body,  the  condition  of  the  dress,  the  means  of  strangulation, 
the  presence  of  marks  of  violence  or  of  blood  on  the  person  of 
the  deceased,  on  his  clothes  or  the  furniture  of  the  room,  or 
both,  rope  or  ligature,  are  circumstances  from  which,  if  ob- 
served  at  the    time,    important  medical    inferences    may   be 


STRANGULATION.  725 

drawn."  The  assassin  either  does  too  little  or  too  much. 
Taylor '  cites  a  number  of  cases  of  simulation. 

Strangulation  is  generally  homicidal.  The  marks  of  fin- 
gers or  of  a  ligature  on  the  neck  suggest  homicide.  This  is 
true  even  if  the  mark  is  slight;  because  infants  and  weakly 
persons  may  be  strangled  by  the  pressure  of  the  hands  on  the 
throat.  Even  a  strong  man,  suddenly  assaulted,  may  lose  his 
presence  of  mind  and,  with  that,  his  power  of  resistance ;  with 
approaching  insensibility  his  strength  still  further  diminishes. 
This  is  true  even  if  his  assailant  is  the  less  powerful.  It  re- 
quires more  address  to  place  a  ligature  on  the  neck  than  to 
strangle  with  the  hand. 

A  victim  may  be  made  insensible  by  drugs  or  blows  and 
then  strangled  by  a  small  amount  of  compression ;  or  suffoca- 
tion by  gags  and  strangulation  may  both  be  attempted. 

The  importance  of  considering  the  position  and  number  of 
the  knots  in  a  cord  is  inentioned  under  suicidal  strangulation. 

In  homicide,  in  addition  to  the  marks  on  the  neck,  there  is 
likely  to  be  evidence  of  a  struggle  and  marks  of  violence  else- 
where on  the  body.  It  is  important,  therefore,  to  notice  any 
evidence  of  such  a  struggle. 

The  nature  of  the  cord  may  assist  in  identifying  the  as- 
sailant. 

It  must  be  remembered  that  homicidal  strangulation  may  be 
committed  without  disturbing  noise  even  when  other  persons 
are  near. 

Simulation. — False  accusations  of  homicidal  strangulation  are  on 
record.  Tardieu  '^  states  that  a  distinguished  young  woman  (for  some 
political  purpose)  was  found  one  evening  at  the  door  of  her  room  ap- 
parently in  great  trouble  and  unable  to  speak.  She  first  indicated  by 
gestures  and  then  by  writing  that  she  had  been  assaulted  by  a  man  who 
tried  to  strangle  her  with  his  hand,  and  also  struck  her  twice  in  the 
breast  with  a  dagger.  She  was  absolutely  mute — did  not  even  attempt 
to  speak — quite  contrary  to  what  is  always  observed  in  unfinished 
homicidal  strangulation.  On  examination  by  Tardieu,  no  sign  of  at- 
tempt to  strangle  was  found,  and  the  so-called  dagger-openings  in  her 
dress  and  corset  did  not  correspond  in  position.  She  confessed  that 
she  had  attempted  deception. 

The  celebrated   Roux-Armand''  case  was  another  instance  of  at- 

i"Med.  Jur.,"  Am.    ed.,  1892.  p.  •  "Pend.."  p- 208. 

419.  Ub.,  p.  242. 


726  STRANGULATION — LAMB. 

tempted  deception.  A  servant  named  Roux  was  found  on  the  ground 
in  the  cellar  of  his  employer  Armand ;  his  hands  and  legs  were  tied 
and  there  was  a  cord  around  his  neck.  He  was  partly  asphyxiated, 
but  after  removal  of  the  ligature  from  his  neck  he  rapidly  recovered, 
except  that  he  was  weak  and  voiceless.  He  stated  by  gestures  that  he 
had  been  struck  by  his  employer  on  the  back  of  the  head  with  a  stick 
and  then  bound  as  described.  The  next  day  he  could  speak.  Armand 
was  imprisoned.  Tardieu  examined  carefully  into  the  case  and  the  re- 
sults may  be  stated  as  follows :  The  asphyxia  was  incipient,  else  he 
could  not  have  so  rapidly  recovered.  The  cord  around  his  neck  had 
not  been  tied — simply  wound  around  several  times ;  the  mark  was 
slight  and  there  was  no  ecchymosis.  Although  the  legs  and  hands 
were  tied,  the  hands  behind  the  back,  there  was  no  doubt  but  that  Roux 
could  and  did  tie  them  himself.  He  had  stated  that  he  had  been  eleven 
hours  in  the  cellar,  in  the  situation  in  which  he  was  found.  This  could 
not  be  true,  for  a  veiy  much  shorter  time,  an  hour  probably  at  the  fur- 
thest, would  have  caused  death,  in  view  of  the  condition  of  asphj-xia 
in  which  he  was  found.  Again,  if  his  limbs  had  been  bound  for  so 
long,  they  would  have  been  swollen  and  discolored  ;  but '  they  were 
not.  Again,  if  the  ligature  had  been  around  his  neck  so  long  as  he 
said,  the  impression  of  it  would  have  been  more  marked.  Again,  if  liis 
stertorous  breathing  had  lasted  long  it  would  have  been  heard  by  neigh- 
bors. The  injury  on  the  back  of  the  head,  said  to  be  due  to  a  blow, 
was  believed  by  Tardieu  to  be  due  to  dragging  him  on  the  ground.  He 
further  had  stated  that  when  he  received  the  blow  on  the  head  he  be- 
came unconscious,  and  yet  he  also  described  how  Armand  bovmd  him 
after  knocking  him  down.  Again,  he  had  made  no  outcry  ;  but  if  he 
had  been  strangled  while  partly  unconscious  and  afterward  recovered 
his  senses,  he  wovild  have  been  unable  to  give  an  account  of  the  matter  ; 
if,  however,  he  had  been  strangled  while  conscious,  there  was  no  rea- 
son why  he  should  not  have  cried  out.  His  inability  to  speak  the  first 
day  was  assumed,  because  what  was  a  simulation  of  absolute  mutism 
should  have  been  simply  a  loss  of  voice.  The  innocence  of  Armand 
was  ultimately  established. 

ILLUSTRATIVE   CASES. 

Homicide. 

1.  Cullingworth :  Lancet, May  1st,  1875,  p.  608.— Woman.  Believed 
to  have  been  intoxicated.  Face,  especially  right  side,  swollen  and 
livid;  a  little  blood  had  oozed  from  mouth,  nose,  and  inner  angle  of 
each  eye.  Immediately  over  (in  front  of  ?)  larynx  and  on  each  side 
of  middle  line  were  marks  of  irregular  outline  such  as  might  be  caused 
by  pressure  of  thumb  and  fingers.     Several  dark,  bruise-like  discolor- 


ILLUSTRATIVE   CASES — HOMICIDE.  727 

ations  on  flexor  surface  of  each  forearm.  Hands  clinched.  Elbows 
flexed.  Discharge  of  faeces  by  rectum.  Necroscopy  :  Brain  and  mem- 
branes normal.  Hyoid  bone  and  laryngeal  cartilages  uninjured.  Mu- 
cous membrane  of  larynx  and  trachea  congested  and  covered  with 
frothy  mucus.  Lungs  intensely  congested.  Several  hemorrhages  ; 
masses  of  tissue  of  each  lung,  chiefly  toward  base,  were  solidified  by 
effused  blood.  All  the  heart  cavities  empty.  Stomach  normal,  empty. 
No  congestion  of  abdominal  viscera. 

2.  Taylor:  ''Med.  Jur.,'"  Am.  Ed.,  1892,  p.  412.— Man  and  woman. 
Strangled  by  cord,  tied  so  tightly  that  there  was  hemorrhage  from 
mouth  and  nose. 

3.  Harvey:  Indian  Med.  Gaz.,  December Isi,  1875, p.  312. — Hindoo 
woman,  age  45.  Strangled  with  the  right  hand.  Necroscopy :  Two 
contusions  and  abrasions  on  temple.  Neck  discolored  from  right  to 
left  jugulars  ;  marks  of  thumb  on  right  side  and  three  fingers  on  left, 
extending  from  jugulars  to  windpipe.  Eyes  half  protruded.  Tongue 
discolored.  Blood-vessels  full  of  clots.  Brain  congested  (?)  and  showed 
external  hemorrhages  (?).  Lungs  normal.  Heart  empty.  Liver  rup- 
tured to  the  extent  of  four  inches,  with  adherent  blood-clot.  Spleen, 
stomach,  and  intestines  normal.  Muscles  of  chest,  both  sides,  congested, 
discolored,  and  there  were  clots  of  blood  over  and  under  them.  First 
six  ribs  of  left  side  and  first  three  of  right  fractured. 

4.  Harris:  Ibid.,  p.  313. — Boy,  age  10.  Abrasions  over  front  of 
neck,  especially  near  left  ear,  probably  from  ligature ;  also  abrasion 
on  upper  part  of  chest,  probably  from  forcible  pressure.  Underneath 
these  marks  the  veins  were  much  distended.  Trachea  minutely  con- 
gested ;  contained  much  frothy  fluid.  Lungs  showed  rupture  of  some 
of  the  air-vesicles  ;  entire  tissues  distended  with  blood  and  frothy  fluid. 
Dark  fluid  blood  in  both  sides  of  heart.  Large  quantity  of  fluid  in 
pericardium.  Brain  much  congested.  Eyes  congested.  Tip  of  tongue 
between  teeth.     Other  organs  normal. 

5.  Mackenzie:  Ibid.,  February,  1889,  j>.  44. — Hindoo  woman,  age 
not  given,  strangled  by  another,  stronger  woman.  Necroscopy : 
Abrasion  on  front  and  lower  part  of  neck  just  above  sternum  and  clav- 
icles ;  four  inches  long,  three  broad;  five  superficial  lacerated  wounds 
on  sides  of  neck,  four  on  left,  one  on  right,  apparently  nail  scratches. 
Two  contusions  below  and  behind  lower  jaw.  Also  contusions  on 
thighs.  No  spots  of  ecchymosis  on  neck.  Contusion  under  skin  of 
lower  part  of  neck  and  upper  part  of  chest,  eight  inches  long,  four 
broad.  Left  greater  cornu  of  hyoid  bone  fractured.  Both  upper  cornua 
of  thyroid  cartilage  fi-actui-ed;  cricoid  fractured  on  each  side.  Larynx, 
trachea,  and  bronchi  contained  pink  frothy  mucus  ;  mucous  membrane 
congested.  Lungs  much  congested  ;  pink  frothy  mvicus  in  bronchi ; 
no  emphysema  nor  apoplexies.  Right  side  of  heart  full  of  dark  blood  ; 
left  side  empty.     Liver,  spleen,  and  kidneys  congested.     Stomach  and 


728  STRANGULATION — LAMB. 

intestines  normal.     Bladder  empty.     Internal  genitals  normal.     Brain 
congested. 

6.  Mackenzie :  Ibid. ,  August,  1888,  p.  232. — Hindoo  man,  age  about 
30.  Strangled  by  soft  cloth  cord.  Necroscopy:  Circular  mark  of 
cord,  one-fourth  inch  diameter  around  lower  part  of  neck;  indistinct 
in  front,  but  distinct  at  sides  and  back.  Superficial  abrasions  of  lix^s 
and  right  cheek  as  from  a  gag.  Faint  marks  of  blisters  on  tem- 
ples. Fingers  not  clinched.  Face  livid,  swollen.  Eyes  closed;  con- 
junctivas congested;  cornesehazy;  pupils  normal.  Tongue  protruding 
and  bitten;  not  swollen.  Fluid  blood  oozing  from  mouth  and  nose. 
Clotted  blood  under  scalp  of  left  temple.  Skin  beneath  cord  had  the 
color  and  consistence  of  parchment.  Muscles  not  torn.  Hyoid,  thyroid, 
and  cricoid  not  injured.  Larynx,  trachea,  and  bi'onchi  empt}";  con- 
gested. Lungs  much  congested.  Some  dark  fluid  blood  in  right  side 
of  heart;  left  side  emj)ty.  Liver,  spleen,  and  kidneys  congested. 
Small  patch  of  congestion  in  stomach.  Intestines  normal.  Bladder 
normal,  contained  some  urine.     Brain  congested. 

7.  Ibid.,  p.  234. — Hindoo  woman,  age  about  40.  Broad,  circular, 
depressed  ' '  parchment "  mark,  one  inch  broad,  around  the  neck,  be- 
tween hyoid  bone  and  thyroid  cartilage;  made  by  two  pieces  of  cloth, 
each  three  feet  seven  inches  long  and  one  inch  broad,  twisted  into  a 
single  cord  and  tied  tightly  by  three  ordinary  knots  on  right  side  of 
neck.  Superficial  wound  on  left  side  of  head  above  ear.  Face  turgid, 
swollen.  Eyes  closed.  Tonguebetween  teeth  and  bitten;  not  swollen. 
Muscles  of  neck  uninjured.  Trachea  uninjured.  Lungs  congested. 
Right  side  of  heart  full  of  dark  fluid  blood;  left  side  empty.  Liver 
and  spleen  congested.     Other  organs,  includitig  brain,  normal. 

8.  Ibid.,  p.  235. — Hindoo  woman,  age  about  25.  Piece  of  cloth 
twisted  tightly  twice  around  mouth.  Double  cord  made  of  two  twists 
of  thin  coir  rope  tied  tightly  around  middle  of  neck  just  below  thyroid 
cartilage;  beneath  the  cord  the  skin  was  "parchment"  like.  No  in- 
jury to  muscles  of  neck  nor  windpipe.  Eyes  closed.  Face  not  flushed. 
Tongue  not  ruptured  nor  bitten.  Hands  not  clinched.  Larynx,  tra- 
chea, and  lungs  congested.  Right  side  of  heart  full  of  dark  fluid  blood  ; 
a  little  fluid  blood  in  left.  Liver,  spleen,  and  kidneys  congested.  Other 
organs,  including  brain,  normal.  Dr.  Mackenzie  considered  death  to 
be  due  to  "asphyxia  or  suffocation." 

9.  Harvey :  Ibid.,  January  Isi,  1876,  p.  2. — Hindoo  woman,  age  12 
oris.  Faint  mark  on  front  of  neck;  none  at  back.  Severe  bruise  on 
top  of  head,  under  which  was  much  clotted  blood,  but  no  fracture. 
Lungs  congested.  Clots  in  right  ventricle;  left  empty.  Brain,  larynx, 
and  trachea  congested.  The  examiner  believed  that  she  had  been 
stunned  and  then  suffocated  by  pressure  of  some  soft  substance  against 
the  neck. 

10.  Ibid. — Hindoo  man,  age  20.     Dead  seven  days;  muchdecompo- 


ILLUSTRATIVE   CASES — HOMICIDE.  729 

sition  and  discoloration.  Wrists  and  ankles  were  bound.  The  two 
corners  at  one  end  of  a  cotton  lungi  (turban)  were  passed  one  on  each 
side  of  the  neck  and  fastened  in  a  knot  under  left  angle  of  jaw.  The 
hingi  was  then  passed  around  the  body  under  the  arms,  etc.,  so  as  to 
draw  upon  the  neck  and  be  buried  deeply  in  the  swollen  flesh.  Under 
the  bands  the  skin  was  blanched;  the  tissues  above  the  bands  were 
black  and  much  swollen.  Lungs,  larynx,  and  trachea  much  congested. 
Heart  empty. 

11.  Ibid. — Cases  of  strangulation  by  sticks  and  other  hard  substan- 
ces. Boy,  age  7  or  8.  No  external  marks  of  violence.  There  was 
hemorrhage  from  mouth  and  nose.  Face  swollen  and  crepitant.  Con- 
gestion of  subcutaneous  tissues  and  bruising  of  muscles  of  right  side  of 
neck.  Mucous  membrane  of  larynx  and  trachea  covered  with  blood. 
Lungs  much  congested;  blood  in  both  pleural  cavities.  Heart  empty  ; 
bloody  serum  in  pericardium.  Brain  congested;  slight  hemorrhage 
on  surface.  Abdominal  organs  normal.  Dr.  Harvey  states  that  the 
boy  was  no  doubt  strangled  by  pressure  of  a  lathi  on  his  neck. 

12.  Ibid. — In  another  subject  two  sticks  were  tightly  tied  together, 
one  pressing  on  the  front,  the  other  on  the  back  of  the  neck,  flattening 
larynx  and  other  soft  parts.  In  the  following  case  some  hard  sub- 
stance, like  a  brick,  had  been  wrapped  in  a  cloth  and  used  for  compres- 
sion. Boy,  age  15.  Necroscopy  :  Large  dark  ecchj^mosis  in  subcuta- 
neous tissue  of  front  of  neck  and  upper  part  of  chest.  Also  marks  of 
violence  on  chest  and  left  side  of  face.  Dissection  of  neck  showed  blood- 
ciot  and  also  laceration  of  muscles.  Trachea  folded  on  itself,  show- 
ing that  compression  had  lasted  several  minutes.  Tongue  protruding 
and  bitten.  Eyes  closed.  Features  calm.  Trachea  much  congested. 
Lungs  congested.  Great  veins  of  heart  and  neck  full  of  fluid  blood. 
Heart,  dark  fluid  blood  in  both  sides,  mostly  in  right.  Brain  and 
membranes  much  congested. 

13.  Pemberton:  Lancet,  May  22(\,  1869,  p.  707. — Woman,  age  60. 
Found  dead.  Nose  partly  displaced  and  cartilages  injured.  Lips  pale. 
Mouth  closed.  Lividity  of  front  of  neck  from  jaw  to  sternum.  Cri- 
coid cartilage  ossified  (cretified  ?)  and  broken  on  left  side  ;  hemorrhage 
in  surrounding  tissues.     Lungs  and  heart  as  usual  in  suffocation. 

14.  Cullingicorth :  Med.  Chron.,  Manchester,  18Si-S5,  i., p.  577. — 
Woman,  married,  found  dead.  Bruise  and  ecchymosis  beneath  the 
ear ;  effusion  of  blood  in  underlying  tissue.  Other  bruises  on  face, 
etc.  Several  bruises  in  mouth,  on  lips  and  tongue.  Blood  dark  and 
fluid.  Brain  and  membranes  much  congested.  No  marks  of  injury 
on  throat.  Lungs  congested ;  surfaces  emphysematous.  Heart  con- 
tained dark  fluid  blood.     Urine  and  fieces  had  been  discharged. 

15.  The  Gouffe  Case. — Murdered  by  Eyraud  and  Bonij^ard  in  1889. 
Archiv  anthropologic  criminelle,  Paris,  1890,  i'.,  pp.  642-716;  in., 
1891,  pp.  17  and  179.     Reports  by  Bernard,   Lacassagne,   and  othei*s. 


730  STRANGULATION — LAMB. 

GoufFe  was  decoyed  into  a  rooin  and  strangled  ;  afterward  Ids  body 
was  tied  up,  placed  in  a  ti'unk,  and  taken  some  distance  away.  The 
murderers  fled  to  America  ;  but  eventually  Bompard  returned  to  France 
and  Eyraud  was  captured ;  both  confessed.  When  found,  the  body 
was  well  advanced  in  putrefaction ;  after  a  very  careful  examination 
was  identified.  He  was  strangled  by  the  j)ressure  of  fingers  ;  the  head 
was  afterward  wrai)ped  in  a  cloth  which  w^as  held  in  place  by  five 
turns  of  a  cord  around  the  neck  ;  traces  of  the  furrows  made  by  these 
cords  were  found.  Heart  empty  ;  no  blood  in  muscles  of  neck  ;  hyoid 
bone  intact  but  superior  thyroid  cornua  fractured  at  base. 

16.  Horteloup:  Ann.  d' Hygiene,  1873,  xxxix.,  pp.  408-416. — Man 
found  dead  on  some  leaves  in  a  fountain  at  bottom  of  staircase  ;  skull 
and  spine  fractured.  The  murderers  stated  that  they  had  struck  him 
on  the  head  with  a  crutch;  then,  believing  him  to  be  dead,  carried  him 
and  threw  him  into  the  foxmtain.  When  examined,  his  face  was  livid, 
tongue  between  teeth  and  bitten  nearly  in  two ;  and  three  parallel 
abrasions  on  left  side  of  neck  and  one  on  right ;  slight  wounds  about 
the  face  in  addition  to  the  fractures  mentioned.  No  report  of  examina- 
tion of  lungs  or  larjTix.  Horteloup  concluded  that  the  man  had  been 
strangled  to  death,  and  that  when  thrown  into  the  fountain,  alighting 
on  his  head,  the  jaws  were  brought  together  and  tongue  bitten. 

17.  Laennec:  Journ.  de  med.  Vouest,  1878,  xii.,  pp.  68-71. — 
Woman,  age  53  ;  attempted  strangulation  by  her  husband.  There  were 
slight  ecchymoses  on  each  side  of  neck  under  angle  of  jaw,  most 
marked  on  left  side  ;  when  seen,  she  compla;ined  of  lassitude  and  lively 
pain  in  hj-pochondria  and  region  of  lower  ribs  antero-laterally ;  no 
sign  of  lesion.  She  stated  that  she  was  awakened  from  sleep  by  pres- 
sure on  neck  and  chest  and  feeling  of  suffocation  ;  she  soon  lost  con- 
sciousness and  so  remained  for  some  hours.  Her  statements  Avere  cor- 
roborated by  other  testimony.  Laennec  considered  the  case  one  of 
prolonged  syncope  from  pressure  on  carotids. 

18.  Lancet,  ii.,  1841-42,  p.  129. — Woman,  found  dead,  her  clothing 
on  fire  and  lower  part  of  her  body  burnt.  Necroscopy  showed  face  and 
neck  swollen  as  low  as  thyroid  cartilage,  and  purple  ;  eyes  prominent 
and  congested  ;  mouth  closed  ;  tongue  not  noticed  ;  front  of  neck  be- 
low swollen  part  showed  two  dark-bro^vn  hard  marks  and  slight  marks 
also  of  pressure  ;  on  incision  the  vessels  were  engorged.  Blood,  fluid  ; 
brain,  congested.  There  were  no  vesications  from  the  burns  and  no 
sign  of  inflammation. 

19.  Algiiie:  ''Etude  med.  and  exp.  de  Vhoniicide  reel  on  simule 
par  sfrangidation,  relativement  aux  attentats  dont  Maurice  Roux 
a  etc  Vobjet,''''  Montpellier,  1864,  p.  121. — This  essay  contains  the  re- 
ports of  many  interesting  experiments  on  animals  and  the  cadaver. 
His  conclusions  in  this  case  were  that  the  victim  had  first  been  struck 
on  the  neck  by  a  club  ;  then  a  ligature  was  placed  on  the  neck,  with 


ILLUSTRATIVE    CASES — HOMICIDE.  731 

many  turns,  tied  tightly,  but  the  knots  did  not  remain  tight.  [The 
marks  were  visible  four  months  afterward.]  The  assailant  then  tied  the 
limbs.     The  victim  recovered  ^dth  temporary  loss  of  voice,  memory,  etc. 

20.  Gatscher:  Mittheil.  d.  Wien.  med.  Doct.  Colleg.,  1878,  iv.,p. 
45. — A  man  found  hanging.  The  examiner  declared  that  he  had  hung 
himself.  Eight  years  afterward,  suspicion  of  violence.  A  commission 
appointed.  The  protocol  had  shown  the  blood  fluid  ;  a  red-brown  dry 
furrow  around  the  neck ;  ecchymoses  in  connective  tissues  of  same ; 
the  entu'e  back  and  posterior  parts  of  limbs  showed  post-mortem  sug- 
gillation.  The  commission  declared  that  the  man  had  been  strangled, 
had  lain  for  at  least  three  hours  on  his  back,  and  then  been  hung  up. 
The  murderer  confessed. 

21.  Ibid.,  p.  46. — Woman,  age  50,  found  dead  in  bed.  Blood  fluid  ; 
two  ecchj'moses  size  of  beans  in  ci'ico-thyroid  muscles  of  each  side ; 
j)atch  of  heiDatization  size  of  fist,  in  lung ;  injury  of  body.  The  ex- 
aminer declared  that  she  had  been  strangled  by  comjiression  of  larynx 
with  two  fingers,  but  he  could  not  say  how  long  the  pressure  had  con- 
tinued, that  is,  whether  she  had  died  of  the  strangulation  or  of  the 
pneumonia.  The  assailant  stated  that  he  had  choked  her  and  when 
she  seemed  to  be  dead,  had  left  her.     The  woman  lived  alone. 

22.  Waidele  :  Memorabilien,  1873,  xviii. ,  pp.  161-167. — Husband 
and  wife  quarrelled  and  fought;  he  stated  that  he  choked  her  with  her 
neckhandkerchief,  and  as  she  turned  round  toward  him,  then  choked  her 
with  his  hand  until  she  died.  The  examiner  declared  that  she  died  of 
asphyxia;  there  was  a  browmish-red  dry  streak  on  each  side  of  the  neck 
in  the  larjTigeal  region  corresponding  to  the  handkerchief,  and  also  two 
small  abrasions  of  skin  which  might  have  been  made  by  the  hands;  he 
concluded,  however,  that  she  had  been  choked  to  death  by  tlie  hand- 
kerchief, because  there  were  no  ecchymoses. 

23.  Rehm:  Friedreich's  Blatter  f.  ger.  Med.,  1883,  xxxiv.,  2>P-  325- 
332. — Woman,  age  37.  Choked  by  the  hand  on  the  neck,  and  at  the 
same  time  assailant's  knee  pressed  against  her  abdomen,  pressing  her 
against  a  wall,  causing  hemoi'rhage  around  the  jjancreas.  Death  stated 
as  due  to  asphyxia. 

24.  Schilppel:  Vier.  ger.  off.  Med.,xiii.,lS70,  pp.  140-156. — Woman, 
just  delivered  of  child,  and  boy  ten  years  old,  were  burnt  to  death  in  a 
fire  which  consumed  their  house.  Examination  of  the  bodies  showed 
upon  the  neck  of  the  boy  a  groove,  and  his  tongue  protruded.  The  hus- 
band was  charged  with  murder,  was  imprisoned,  and  ccmimitted  suicide. 

25.  Weiss:  Ibid.,  xxvii.,  1877.  pp.  239-244.— Woman  strangulated 
bj'  the  bands  of  her  nightcap. 

26.  I.HnardandDieu:  Rev.  casjiid.,  Paris,  1841.  p.  101.— Man,  age 
65.  Marks  of  fingers  on  face  and  neck.  Opinion  that  he  had  been  as- 
saulted by  ttvo  men.     The  two  murderers  confessed. 

27.  Friedberg:    Gericht.    gutacht.,    1875,  jip.   211-224.— Woman 


732  STRANGULATION — LAMB, 

found  hanging  to  branch  of  tree,  but  in  half-lying  position,  feet  on 
ground.     Opinion  given  that  she  had  been  strangled  and  then  hung. 

^8.  Tardieu:  '' Pendaison,''^  p.  22B. — New-born  infant.  Question 
whether  its  death  was  due  to  asphyxia  from  compression  of  neck  by  the 
mother  with  her  hand  to  hasten  delivery.  He  doubted  the  possibility 
of  the  mother  thus  assisting  her  child.  But  the  direction  of  the  seven 
excoriations  on  its  face  contradicted  the  mother's  statement.  The  traces 
of  finger-nails  wei-e  distinct.  The  lungs  and  alimentary  canal  showed 
that  the  child  had  lived.     Opmion  given,  infanticide. 

29.  Ibid.,  p.  219. — Woman,  advanced  in  years,  habits  dissipated; 
found  strangled.  Four  excoriations  on  left  side  of  lar^Tix,  one  on 
right;  blood  in  subcutaneous  tissue.  Marks  of  nails  and  long  scratches 
on  wrist.  Injuries  on  face  and  left  breast.  She  had  been  strangled  by 
one  hand  on  her  neck  while  the  other  was  over  her  mouth  and  nose. 
Face  li%Hd;  eyes  congested;  frothy  bloody  liquid  fiowmg  from  mouth 
and  nose;  tongue  behind  teeth;  bloody  froth  in  larynx  and  trachea; 
lungs  large,  much  congested,  splenized  in  places,  surface  emphysema- 
tous, looking  like  white  spots;  black  fluid  blood  in  heart;  brain  some- 
what congested. 

30.  Ibid.,  p.  216. — Wife  of  the  celebrated  painter  Gurneray;  found 
dead  in  bed,  where  a  fire  had  been  placed  and  slowly  burnt  and  charred 
her  lower  limbs,  belly,  chest,  and  right  hand.  A  running  noose  around 
her  neck.  Injuries  of  head;  face  livid;  tongue  between  teeth;  brain 
normal;  mai'k  of  cord  slight;  subcutaneous  tissue  infiltrated  Tvith  blood. 
Marks  of  pressure  on  chest;  bloody  froth  in  trachea;  lungs  congested; 
heart  contained  fluid  blood.  Opinion  given  that  she  had  been  struck 
on  head,  causing  unconsciousness;  then  partly  strangled  and  partly 
suffocated  by  pressure  on  neck  and  chest.  Body  afterward  burnt  to 
cover  up  the  crime. 

31.  Ibid.,  p.  211. — Three  murders  by  one  man.  All  women.  All 
injured  about  the  head  and  then  strangled  by  both  hand  and  ligatvire. 
Two  died;  one  had  an  odor  of  alcohol  and  had  apparently  not  resisted. 
The  third  was  resuscitated.  She  was  strong  and  stout,  and  resisted. 
Marks  of  fingers  and  nails  on  neck.  Afterward  she  had  headaches  and 
giddiness  for  a  long  time. 

Suicide. 

32.  Francis:  Med.  Times  and  Gaz.,  December  2d,  1876,  p.  634.— 
Hindoo  lunatic,  a  giant,  strangled  himself.  He  passed  two  or  three 
coils  of  stout  thread  ai-ound  his  neck,  attached  the  ends  securely  to  his 
wrists,  and  then  extended  his  arms  to  their  utmost  limit.  This  oc- 
curred during  a  ten-minute  absence  of  his  attendant,  who,  returning, 
found  the  man  had  fallen  to  one  side  from  a  kneeling  position,  with  his 
back  against  a  wall,  quite  dead.     No  reason  to  suspect  homicide. 


ILLUSTRATIVE   CASES — SUICIDE.  733 

33.  Badahur:  Indian  Med.  Gaz.,  December,  1882,  p.  330. — Hindoo 
woman,  age  about  17,  strangled  herself  with  the  border  of  her  saree. 
Necroscopy  :  Circvilar  depressed  mark  caused  l)y  the  border  of  a  band 
of  cloth,  which  she  had  passed  in  three  coils  around  her  neck,  the  coils 
tightly  ovei'lapping  each  other ;  the  short  ends  had  been  knotted  to- 
gether with  a  "granny"  knot  at  the  back  of  the  neck,  like  the  native 
women  tie  up  their  hair.  The  coils  were  so  tight  that  they  had  to  be 
cut  off.  Face  swollen,  dark  purple  ;  conjunctivte  congested.  Tongue 
between  the  shut  teeth  ;  bloody  froth  issuing  from  mouth  and  nostrils 
[the  examination  was  in  September,  thirty  hoiu-s  after  death].  Skin  of 
neck  reddened  in  nearly  a  continuous  line  all  around,  both  above  and 
below  the  band,  about  three-fourths  inch  vside,  evidently  caused  by  the 
pressure  of  the  three  folds.  Considerable  ecchymosis  above  and  below 
the  coils  ;  the  neck  underneath  the  folds  was  swollen  and  red.  Brain 
and  membranes  much  congested.  Trachea,  pharynx,  and  cpsoi)hagus 
congested.  Lungs  congested.  Right  cavity  (auricle  ? )  of  heart  full, 
left  empty.  Liver,  spleen,  and  kidneys  congested.  Intestinal  peri- 
toneum congested.  Stomach  contained  half -digested  food.  Small  in- 
testines empty ;  faeces  in  large  intestine.  Bladder  empty.  Uterus 
and  appendages  congested  ;  no  evidence  of  catamenia. 

34.  Harris:  Ibid. — Woman;  made  a  loop  of  her  hair  around  her 
neck,  knelt  down  so  as  to  pvit  it  on  the  stretch  ;  when  fovind,  was 
nearly  dead. 

35.  Geoghegan:  Taylor's  ''Med.  Jur.,''  Am.  Ed.,  1892,  p.  413.— 
Informed  Dr.  Taylor  of  a  suicidal  strangulation  by  a  ribbon.  The 
mark  on  the  neck  nearly  disappeared  after  removing  the  ligature. 
There  was  bleeding  from  one  ear,  from  rupture  of  tym]:)anic  membrane. 
No  froth  from  mouth  or  nostrils  ;  but  little  lividity  or  swelling  of  face. 

36.  Taylor:  ''Med.  Jur.,''  Am.  Ed.,  1892,  _p.  418.— Boy:  found  dead 
with  handle  of  pitchfork  under  necktie  ;  marks  of  strangulation  on 
larynx  ;  eyes  and  tongue  protruded  ;  tongue  livid  and  marked  by  teeth  ; 
brain  congested.  Also  man  found  dead  with  handkerchief  tied  around 
neck  and  twisted  by  razor  strop.  Taylor  considered  both  as  suicides. 
Also  a  third  case  (Amer.  edit.,  1880,  p.  465).  A  man  of  unsound  mind 
twisted  a  fishing-net  firmly  around  his  neck  several  times  ;  it  remained 
secure  without  the  aid  of  a  knot. 

37.  Fargues:  Rec.  de  mem,,  demed.,  etc.,  Paris,  1869,  xxii.,  pp. 
443,  444. — Soldier,  age  32,  while  drunk,  strangled  himself  with  his 
handkerchief,  wrapping  many  folds  around  his  neck,  making  a  deep 
furrow  without  ecchymosis  ;  face  pale,  eyes  closed,  lips  partly  closed. 

38.  Borchard:  Jour,  de  med.  de  Bordeaux,  1860,  t'.,  p.  349  et  seq. — 
Collation  of  cases  of  suicide  by  strangulation:  First,  an  otiicer  who 
placed  his  sabre  scabbard  under  his  cravat.  Second,  a  woman  strangled 
herself  with  a  silk  cravat,  tightly  tied.  Third,  a  man  tied  the  sleeve  of 
his  jacket  around  his  neck  and  fastened  the  end  to  a  Avindow,  so  that 


734  STRANGULATION — LAMB. 

the  strangulation  was  partly  due  to  suspension.     Fourth,   a  woman 
strangled  by  a  cord. 

39.  Hofmann:  Wien  med.  Presse,  1879,  xx.,  p.  36,  et  seq.  Also 
Lehrbuch,  p.  559. — Woman,  age  20,  found  dead  in  bath-room,  with  a 
thick  thread  passed  three  times  around  the  neck,  and  tied  tightly  in 
front  at  the  second  and  third  turns ;  so  tightly  that  even  after  cutting 
the  cords  the  pressure  continued.     No  signs  of  violence.     (Illustration.) 

40.  Zillner:  Wien  med.  TFbcTi.,  1880,  icxo;.,  pj>.  969,  999.— Woman, 
age  33 ;  found  dead  on  the  floor ;  a  neck -handkerchief  tied  in  a  firm 
knot  in  front  of  the  neck  ;  and  underneath,  a  cord  passed  twice  around 
the  neck  and  knotted  in  front  in  the  middle  line  between  the  larjTix 
and  hyoid  bone.  Blood  was  flowing  from  the  ears.  No  sign  of  \\o- 
lence  or  struggle. 

41.  Bollinger:  Friedreich's  Blatter  f.  ger.  Med.,  1889,  xl.,  p.  3.— - 
Man,  age  48  ;  melancholic  ;  found  dead.  Had  torn  up  part  of  a  sheet, 
fastened  it  around  his  neck  and  the  ends  around  a  bedpost,  then 
placed  his  feet  agamst  the  farther  post  and  pressed,  tightening  the  liga- 
ture.    (Illustration.) 

42.  Moth:  Ibid.,  p.  9. — Man,  age  68;  melancholic;  found  dead  ix 
bed.  Had  made  loose  ligature  of  cravat,  tied  into  it  a  piece  of  wood; 
the  ligature  lay  in  front  of  larynx.     Had  attempted  suicide  once  before. 

43.  Ibid. — Son-in-law  at  36  years  of  age  had  committed  suicide  in 
the  same  way. 

44.  Ibid. — ^IVIan,  age  63  ;  found  dead  in  his  bed;  cord  around  neck 
inclosing  piece  of  wood. 

45.  Maschka:  Vier.  ger.  off.  Med.,  1883,  xxxviii.,  pp.  71-77. — 
Woman,  age  45.  A  cloth  was  found  wound  tightly  three  times  around 
her  neck  in  front  of  larynx,  and  tied  in  a  simple  knot.  There  were  also 
injuries  of  the  head.  At  first  it  was  thought  that  she  had  been  murdered, 
but  Maschka  concluded  that  she  had  committed  sviicide. 

46.  Ibid. — Woman;  supposed  to  have  been  murdered  by  her  son. 
There  were  marks  on  the  neck  and  other  injuries,  and  hemorrhage 
into  the  brain.  Maschka  conclvided  that  the  marks  on  the  neck  were 
not  due  to  strangulation. 

47.  Hackel:  Dorpat  Diss.,  1891,  p.  34. — Man,  age  48;  strangled 
himself  with  part  of  a  mattress.  Was  found  lying  on  his  back,  dead, 
holding  the  ends  in  his  hand.     There  was  a  double  mark  of  ligature. 

48.  Sinner:  Zeitsch  f.  Med-beamte,  1888,  i.,  pp.  364-368.— Wom- 
an ;  suicided  by  choking  herself  with  her  hands. 

For  other  cases,  see  Tidy,  "Med.  Jur.,"  Cases  20  to  65  ;  Maschka, 
"Handbuch,"  p.  625. 

Accident, 

49.  Bedie:  Rec.  de  mem.  de  Med.,  etc.,  Paris,  1866,  xvi.,  pp.  482- 
484. — Soldier,  age  39,  found  dying,  Ijing  on  his  bed  ;  had  returned  to 


ILLUSTRATIVE   CASES — ACCIDENT.  735 

his  room  drunk  and  lay  down  in  his  uniform.  Face  much  congested  ; 
lips  cyanosed ;  eyes  closed.  Skin  of  neck  below  thyroid  cartilage 
showed  deep  mark  from  pressure  of  collar  of  uniform  wliei-e  the  collar 
was  fastened ;  had  passed  urine  into  his  clothing.  When  examined 
after  death  his  face  was  pale  yellow,  lips  cyanosed,  eyes  closed ;  large 
hypostatic  patches  ;  traces  of  pressure  on  neck  still  visible  ;  lungs  con- 
gested ;  larynx,  above  level  of  ]wessure,  congested  ;  below  was  normal. 
Fibrin  clots  in  both  ventricles  of  heart.  Liver,  spleen,  stomach,  and  in- 
testines congested.  Brain  somewhat  congested.  Bladder  contained 
uxine. 

50.  Liegey :  Jour,  de  Med.  chir.  et pharm.,  Brussels,  1868,  xlvi., 
pp.  339-342. — Infant,  age  8  mouths,  accidentally  strangled  ;  it  had  been 
placed  in  its  cradle  ;  coverlet  over  it  and  held  in  place  by  a  cord  passed 
across.  Some  time  afterward  it  was  found  dead  beside  the  cradle,  its 
head  hanging  with  the  right  side  pressing  on  the  cord.  Liegey  had  the 
mother  replace  everji:hing  as  it  had  been  and  satisfied  himself  that  the 
aljove  statement  was  correct.  When  found,  the  face  was  pale,  eyes 
and  mouth  closed ;  transverse  furrow  on  right  side  of  neck,  level  of 
larynx,  3.5  cm.  long,  one  deep;  muscles  in  vicinity  congested.  Lungs 
congested.  Right  side  of  heart  contained  clotted  blood  ;  left  side  nearly 
empty.     He  concluded  that  the  case  was  one  of  accidental  strangulation. 

51.  Friedherg:  Gericht.  gutacht.,  p.  240. — New-born  child  found 
dead  in  closet.  Mother  stated  that  she  had  taken  the  child  by  the 
neck  and  drew  it  into  the  world.  Opinion  given  that  the  child  had 
been  accidentally  choked  to  death  by  the  hand. 

For  other  cases,  see  Tidy,  "Med.  Jur.,"  Cases  15  to  19,  59,  and  G2; 
Maschka,  "Handbuch,"  p.  623. 

HANGING. 

Hanging  is  a  form  of  mechanical  suffocation  by  ligature  of 
the  neck,  in  which  the  constricting  force  is  the  weight  of  the 
body  itself.  The  French  call  it  "  Pendaison"  or  "Suspension," 
preferably  the  former;  the  Germans,  "Erhangen."  The  ex- 
pression "  incomplete  hanging"  is  applied  to  those  cases  in  which 
the  subject  is  partially  supported ;  kneeling,  sitting,  or  other- 
wise. The  same  expression  has  also  been  used  for  cases  which 
did  not  prove  fatal. 

The  pathological  effects  of  hanging  are  partly  those  of 
strangulation,  to  which  must  be  added  the  effects  of  the  weight 
or  fall  of  the  body,  sustained  as  it  is  only  by  some  form  of  liga- 
ture around  the  neck.  These  additional  injuries  will,  of  course, 
be  proportioned  to  the  weight  of  the  body,  length  of  rope,  and 
suddenness  of  the  fall. 


736  HANGnSTG — LAMB. 

In  some  countries,  as  the  United  States,  England,  Germany,  and 
Austria,  hanging  is  a  mode  of  capital  punishment.  It  is  desirable  that 
for  judicial  pui'poses  it  should  be  divested,  as  far  as  possible,  of  un- 
necessarily cruel  features  ;  the  victim  should  quickly  be  made  insensible, 
and  death  be  s^ieedy.  Many  suggestions  to  this  end  have  been  made, 
among  which  is  that  of  Haughton,  He  recommended  that  the  drop  be 
long,  say  ten  feet,  so  that  the  cervical  vertebrae  may  be  dislocated.  He 
also  advised  that  the  knot  be  placed  under  the  chin.  Others  advise  that  it 
be  placed  under  the  left  ear  ;  and  others  yet,  as  Barker,  of  Melbourne, ' 
near  the  spine.  In  any  event  the  rope  should  be  "freely  elastic."  G. 
M.  Hammond  ^  thinks  that  the  object  in  judicial  hanging  should  be 
strangulation,  and  that  the  criminal  should  be  pulled  up  and  left  to 
hang  thirty  minutes ;  the  rope  should  be  soft  and  flexible  so  as  to 
closely  fit  the  neck  ;  a  weight  should  be  attached  to  the  feet  of  persons 
under  150  pounds.  Larimore  ^  also  advocates  strangulation  instead  of 
attempting  dislocation  of  the  vertebra?.  Porter  *  suggests  that  for  dislo- 
cation the  noose  be  drawn  tightly  around  the  neck  at  the  last  moment, 
the  knot  being  either  at  one  side  or,  still  better,  in  front.  Dislocation 
may  be  still  further  assured  if  a  hollow  wooden  or  leaden  ball  be  placed 
over  the  knot  close  to  the  neck,  thus  forming  a  fulcrum  to  throw  the 
spinal  cohimn  out  of  the  perpendicular  line  at  the  point  of  pressure. 

Hanging  is  a  common  mode  of  suicide,  especially  in  insane 
asylums  and  prisons.  It  is  sometimes  accidental,  and  rarely 
homicidal.  It  is  said  to  have  been  attempted  for  erotic  pur- 
poses. 

The  compression  of  the  neck  acts  in  line  with  the  axis  of  the 
body;  while  in  strangulation  it  acts  perpendicularly  to  that 
axis. 

The  final  cause  of  death  will  depend  on:  1.  The  sudden- 
ness and  completeness  of  interference  with  the  access  of  air* 
asphyxia.  2.  Pressure  on  the  large  veins  of  the  neck,  pre- 
venting the  return  of  blood  from  the  head,  causing  congestion 
of  brain  and  coma.  3.  Pressure  on  the  large  arteries  of  the 
neck,  preventing  access  of  blood  to  the  brain ;  causing  anaemia 
of  the  brain  and  syncope.  4.  Injury  to  spinal  cord  or  pneu- 
mogastric  nerves  or  all  of  them ;  causing  paralysis.  A  com- 
bination of  numbers  1  and  2  is  usually  found  in  suicidal  hang- 
ing;   and   probablj^    all   of   them    in   homicidal    and    judicial 

'Med.  Times  and  Gaz. ,   1871,  i.,  ^  Ohio  Med.  Record,  1878,  ii.,  pp. 

p.  671,  and  1876,  i.,  p.  93.  350-352. 

^ Med.  Record,  N.  Y.,  1882,  xxii.,  ^Arch.   Laryngol.,    N.   Y.,    1880, 

p.  428.  i.,  p.  144. 


•HANGING.  737 

hanging.  The  more  protected  the  air-passages  are  from  pressure 
the  greater  part  will  coma  or  syncope  have  in  the  cause  of 
death.  , 

Mackenzie,'  as  the  result  of  examination  of  130  suicidal 
hangings,  saj'S  that  119  died  of  asphyxia,  8  of  asphj'xia  and 
apoplexy,  2  of  syncope,  and  1  of  apoplexy  alone.  Coutagne'^ 
thinks  oedema  of  the  lungs,  "oedema  carmine,"  has  an  impor- 
tant part  in  causing  death. 

Tlie  following  conditions  tend  to  produce  asphyxia :  a  tight 
ligature,  or  a  loose  ligature  above  the  hyoid  bone.  To  produce 
coma,  a  loose  ligature  pressing  against  the  hj^oid  bone  or 
larynx,  especially  a  cretified  larynx.  To  both  asphyxia  and 
congestion  of  brain,  a  ligature  just  beneath  the  lower  jaw,  or 
around  lower  part  of  neck. 

Hofniann  ^  states  that  when  the  ligature  is  placed  between 
the  larynx  and  hyoid  bone,  the  base  of  the  tongue  is  pushed 
upward  against  the  posterior  wall  of  the  pharj'nx,  completely 
stopping  respiration  and  causing  asphyxia.  Ta3'lor*  states 
that  if  the  rope  presses  on  or  above  the  larynx,  the  air-passages 
are  not  so  completely  closed  as  when  pressure  is  below  the 
larynx.  In  the  latter  case  death  would  be  immediate ;  in  the 
former  a  slight  amount  of  respiration  might  continue.  The 
instantaneous^  loss  of  consciousness  is  due,  not  to  as23h3'xia 
alone,  but  to  compression  of  the  large  vessels,  especiall}-  the 
carotids,  against  the  transverse  processes  of  the  vertebrae,  caus- 
ing rupture  of  the  middle  and  inner  coats,  and  at  the  same 
time  compression  of  the  jugular  veins  and  pneumogastric 
nerves.  Immediate  unconsciousness  will  almost  certainly  fol- 
low compression  of  the  pneumogastrics.  He  also  believes  that 
the  loss  of  consciousness  and  of  power  of  self-help  occur  at  the 
moment  that  the  noose  is  tightened  around  the  neck.  There  is 
no  record  of  an}^  one  who  attempted  suicide  by  hanging  seek- 
ing to  recover  himself,  although  no  doubt  some  would  have 
done  so  if  the  speedy  unconsciousness  had  not  prevented.  Hof- 
mann  mentions  the  case  of  a  man  who  was  found  hanging,  and 
with  a  loaded  revolver  in  his  hand,  apparently  having  intended 
to  shoot  as  well  as  hang  himself,  but  lost  consciousness  before 

•  Indian  Med.  Gaz. ,   1888,  xxiii.,  3"Lei„.buch   f.    ger.    Med.,"   ."Jth 

p.  299.  ed.,  1890-91. 

-Archiv.    anthrop.    crim. ,  Paris,  *"Med.  Jur. ,"  Am.  Ed.,  1892,  p. 

1886,  i.,  p.  229.  394. 
47 


738  HANGING — LAMB. 

he  had  time  to  discharge  the  revolver.  According  to  him  the 
causes  of  death  are  three :  occlusion  of  the  air-passages,  inter- 
ruption of  passage  of  blood  to  brain,  and  compression  of  pneu- 
mogastric  nerves. 

Von  Buhl '  experimented  on  cadavers  and  concluded  that  in 
hanging,  the  epiglottis  and  arytenoids  are  pressed  over  the 
glottis,  and  the  tongue  and  the  oesophagus  against  the  vertebra, 
causing  death  by  apnoea.  When  the  trachea  was  isolated  from 
the  vessels  and  tied,  the  air-passages  below  became  dilated  and 
the  lungs  emphysematous  and  anaemic.  The  heart  continued 
to  beat  and  blood  to  circulate. 

The  vertebral  arteries  being  much  smaller  than  the  carotids, 
the  circulatory  disturbance  in  the  brain  is  not  adjusted  with 
sufficient  promptness.  Compression  of  the  pneumogastrics,  ac- 
cording to  Waller,"  has  caused  subjects  to  fall  to  the  ground  as 
if  struck  by  lightning.  He  holds  that  the  unconsciousness  in 
hanging  is  the  result  of  the  compression  of  the  pneumogastric 
nerves  and  not  of  the  arteries.  Thanhofer  ^  knew  a  student  who 
had  acquired  a  certain  dexterity  in  compressing  these  nerves. 
One  day  he  compressed  the  two  nerves,  his  pulse  stopped  and 
he  became  unconscious.  Thanhofer  ^  tried  bilateral  compression 
of  paeumogastrics  in  a  young  man  sentenced  to  be  executed. 
The  pulse  fell  at  once  and  the  heart  soon  stopped;  the  eyes  were 
fixed  and  glassy.  It  was  some  time  before  he  regained  con- 
sciousness and  for  two  days  there  was  malaise. 

Hofmann  says  that  the  compression  irritates  and,  in  a 
higher  degree,  paralj^zes  the  pneumogastric  nerves  and  causes 
disturbance  of  the  action  of  the  heart. 

Faure '  denies  that  the  constriction  of  the  vessels  of  the  neck 
has  any  effect  in  the  production  of  symptoms. 

Coutagne  believes  that  the  pressure  on  the  pneumogastric  nerve  is 
a  factor  in  causing  death.  He  hung  two  dogs;  in  one  the  pneumogas- 
tric nerves  were  dissected  out  and  placed  in  front  of  the  hgature;  this 
dog  (No.  1)  lived  a  quarter  of  an  hour  and  died  of  pure  asphyxia  with 
efforts  at  inspiration  continued  to  the  end.     The  other  dog  (No.  2),  in 

»Aertz.  Intel.  Bl.,  1876,  xxiii.,  p.  ^Centralb.   f.   med.   Wiss..    1875, 

324.  xiii.,  p.  403. 

2 Practitioner,  1870,  iv.,  p.  193.  ^Arch.  gen.  de  Med.,   1856,   vii., 

3  Mitt.  d.  Wien  med.    Doct.  Col-      p.  310. 
leg.,  1878,  iv. ,  pp.  97-112.  '^  Archiv.  anthrop.  crim.,    Paris, 

1886,  i. ,  p.  229. 


HANGING.  739 

which  the  nerves  were  compressed,  died  in  fire  minutes.  In  both,  the 
abdominal  organs  were  congested  and  the  cavities  of  the  heart  were  full. 
The  lungs  of  the  first  were  dry  and  uniformly  red;  of  the  second  were 
resisting,  crepitant,  and  quite  oedematous.  No  subijleural  ecchymoses 
in  either.  The  experiments  on  animals  by  Corin  '  led  him  to  conclude 
that  pressure  on  the  pneumogastrics  caused  nicreased  frequency  of  the 
heart-beat  and  slowing  of  respiration.  Pellier  -  considers  the  subject 
quite  fully.  It  would  appear  that  the  pressure  on  the  pneumogastrics 
disposes  to  stop  the  action  of  the  heart  and  cause  rapid,  perhaps  instant 
death.  The  pressure  on  the  carotids  causes  cerebral  anosmia  and  is  then 
only  a  secondary  cause.  Le^'y ''  does  not  think  the  action  of  the  pneu- 
mogastrics is  sufficiently  well  known. 

Tidy  states  that  a  dog  lived  for  three  hours  suspended  by  a 
rope  placed  above  an  opening  in  the  windpipe;  and  that  Smith ' 
mentions  the  case  of  a  criminal  who  was  hung ;  Chovet  tried  to 
save  the  man  b}'  making  an  opening  in  the  trachea  before  the 
execution  and  introducing  a  small  tube.  The  man  was  alive 
forty-five  minutes  after  the  drop,  but  could  not  be  resuscitated, 
although  the  surgeon  bled  him. 

In  a  small  proportion  of  cases  of  hanging,  homicidal  and 
judicial,  death  occurs  by  dislocation  of  the  spine.  This  is  said 
to  have  been  first  noticed  by  the  celebrated  Louis,  who  states 
that  the  Paris  executioner  was  in  the  habit  of  giving  a  violent 
rotary  movement  to  the  body  of  the  convict  as  the  trap  was 
sprung,  causing  a  dislocation  of  the  odontoid  process  and  com- 
pression of  the  cord  and  almost  instant  death.  Taylor '"  says 
that  for  dislocation  the  body  must  be  heavy  and  the  fall  long 
and  sudden.  Devergie "  found  this  to  occur  in  about  two  per 
cent  of  cases.  It  is  said  that  the  Paris  hangman  placed  the 
slip-knot  under  the  chin  in  front,  which  is  as  Dr.  Haughton 
suggests. 

Death  may  occur  from  secondary  causes  after  apparent  re- 
covery ;  from  congestion  of  brain  and  other  lesions  of  the  ner- 
vous sj'^stem ;  these  may  prove  fatal  at  remote  periods. 

Fracture  of  the  odontoid  process  according  to  M.  de  Fosse 
is  more  common  than  dislocation,  and  the  giving  away  of  the 
intervertebral  substance  more  likely  than  either  of  the  others. 

'Bull.    Acad.    Roy.    Med.,    1893,  *  "Forensic  Med.,"  Appendix,   p 

vii.,  pp.  831-342.  561. 

2  Lyon  thesis,  1883,  No.  188.  ^"Med.  Jur.,"  Am.  Ed.,  1892,   p. 

=* Paris  thesis,   1879,    No.    172,   p.  394. 
39.  '^Tidy,  op.  cit.,  p.  240. 


740  HANGING — LAMB. 

The  phrenic  and  other  respiratory  nerves  are  likely  to  be  para- 
lyzed; the  vertebral  and  carotid  arteries  may  be  ruptured.  The 
medulla  oblongata  is  also  likely  to  be  fatally  injured.  Death 
may  also  occur  from  hemorrhage  upon  the  cord,  causing  pres- 
sure. 

Besides  the  ropes  used  as  ligatures  in  judicial  hanging,  al- 
most every  conceivable  article  that  could  be  made  into  the  sem- 
blance of  a  cord  has  been  used  by  suicides ;  usually,  however, 
some  portion  of  the  bedding  or  clothing.  When  one  resolves  on 
suicide,  all  the  precautions  of  the  managers  of  prisons  and 
asylums  fail  to  prevent. 

The  secondary  effects  in  those  who  recover  involve  the 
respiratory  organs — dyspnoea,  cough,  bloody  sputa,  bronchial 
rales,  and  fever;  or  the  nervous  system — aphonia,  dysphagia, 
numbness,  chilliness,  spasms,  pains  in  neck,  face,  or  shoulder ; 
sometimes  paralysis  of  bladder  and  rectum,  and  loss  of  memorj^. 
The  marks  on  the  neck  slowly  disappear.'  Verse ^  collated  a 
number  of  cases  in  which  the  hanging  was  not  completed  and 
the  subjects  lived  for  var3^ing  periods  afterward.  Wagner  and 
Mobius '  discuss  the  spasmodic  seizures  and  amnesia,  which 
often  appear  after  the  restoration  from  hanging. 

Symptoms  in  Hanging. 

Obviously  these  will  be  in  some  respects  identical  with  those 
of  strangulation.  In  considering  the  latter,  some  of  the  simi- 
larities and  dissimilarities  of  symptoms  and  post-mortem  ap^ 
pearances  of  strangulation  and  hanging  were  mentioned. 

Death  may  be  immediate  and  without  symptoms. 

There  is,  of  course,  no  preliminary  or  "  waiting"  stage,  as 
in  strangulation,  except  in  those  rare  cases  of  suicide  where 
the  subject  inclines  his  body  forward  with  his  neck  against  the 
ligature,  his  body  being  near  the  floor  or  ground.  The  absence 
of  a  drop  makes  this  condition  very  similar  to  ordinary  strangu- 
lation. The  body  of  a  victim  of  homicide  might  be  similarly 
placed  for  the  purpose  of  deception,  and  also  that  of  a  subject 
previously  made  unconscious ;  in  these  cases  the  symptoms  and 
appearances  would  resemble  those  of  strangulation. 

'Tardieu,  "Pendaison,"1870,  p.  16.  mimch.   med.  Woch.,  1893,  xl., 

2  Lyon  thesis,  1891,  No.  647.  pp.  87-91,  127-129,  194. 


SYMPTOMS   IN   HANGING.  741 

lu  other  words  it  is  necessary  that  there  should  be  a  drop  or 
fall,  or  at  least  the  weight  of  the  body,  to  produce  the  charac- 
teristics of  hanging.  The  jerk  of  the  fall  or  sudden  dependence 
of  the  body  upon  the  ligature  causes  a  much  greater  constric- 
tion of  the  ligature  on  the  neck,  and  in  a  different  direction, 
than  in  strangulation ;  and  also  a  much  greater  pressure  on  the 
blood-vessels  and  nerves  of  the  neck. 

Tidy  divides  hanging  into  three  stages : 

First  stage:  Partial  stupor  lasting  thirty  seconds  to  three 
minutes,  according  to  the  length  of  the  drop,  the  weight  of  the 
body,  and  tightness  of  the  constriction.  The  testimony  seems 
to  be  uniform  that  there  is  no  pain  in  this  stage;  indeed,  that 
the  feeling  is  rather  one  of  pleasure.'  The  subjective  symptoms 
described  are  an  intense  heat  in  the  head,  brilliant  flashes  of 
light  in  the  eyes,  deafening  sounds  in  the  ears,  and  a  heavy 
numb  feeling  in  the  lungs.  Sometimes  there  is  a  feeling  of 
absence  of  weight.  In  many  cases  efforts  to  breathe  are  made 
for  a  time  after  the  air-passages  are  closed.  It  is  doubtful 
whether  there  are  any  voluptuous  feelings,  as  has  been  sug- 
gested. 

Chowne  -  reports  the  case  of  Hornshawor,  "Monsieur  Gouffe,"  who 
was  in  the  habit  of  hanging  himself  for  exhibition.  He  fixed  the  noose 
with  a  knot  that  would  not  slip,  sprang  into  it,  the  rope  coming  behind 
the  lower  jaw  and  the  two  sides  passing  up  behind  the  ears.  He  would 
hang  for  ten  to  fifteen  nnnutes,  and  in  addition  to  his  own  weight 
would  sustain  one  hundred  and  fifty  pounds.  Three  times  the  rope 
slipped  and  he  would  have  died  but  for  the  help  of  spectators.  He  de- 
scribed his  sensations  as  follows:  He  lost  his  senses  all  at  once.  The 
instant  the  rope  got  in  the  wrong  place  he  felt  a.s  if  he  could  not  get  his 
breath,  as  if  some  great  weight  was  at  his  feet;  and  could  not  move  only 
to  di-aw  himself  up;  felt  as  if  he  wanted  to  loosen  himself  but  never 
thought  of  his  hands.  He  said:  "You  cannot  move  your  arms  or  legs 
to  save  yourself;  you  cannot  raise  yoiu*  arms;  you  cannot  think." 

Taylor*  mentions  the  case  of  Scott,  the  American  diver,  who  was  in 
the  habit  of  making  public  exhibitions  of  hanging.  The  last  time  he 
hung  for  thirteen  minutes,  the  spectatoi-s  not  suspecting  that  he  had 
died.  It  is  supposed  that  the  ligature  had  slipped.  Taylor  also  rejwrts 
a  case  (from  Dr.  Elliott)  of  a  boy,  age  11,  Avlio,  to  frighten  his  jjareuts, 
tied  a  knot  in  a  handkerchief  and  put  it  around  a  loiob  and  his  neck  iu 
one  continuous  ligature.     The  pressure  against  the  trachea  was  so  ef- 

'  Tracy,  Pop.  Sci.  Mo.,  1878.  xiii.,         ^  Lancet.  1847,  i.,  p.  403. 
pp.  349-354.  '  "  Med.  Jur. , "  Am.  Ed. .  1893,  p.  39G. 


742  HANGING — LAMB. 

fective  that  he  became  unconscious  and  died  before  he  could  reheve 
himself. 

Second  stage :  The  subject  is  unconscious  and  convulsions 
usually  occur.  Tlie  convulsed  face,  however,  is  a  part  of  the 
general  agitation  and  does  not  indicate  pain.  In  judicial  cases 
the  face  is  covered  with  a  cap.  Sometimes  there  are  no  spasms. 
Urine,  faeces,  and  semen  may  be  discharged  in  any  stage. 
Jaquemin,  however,  in  forty-one  cases  of  hanging,  noted  dis- 
charge of  urine  and  fseces  onl}"  twice.  Semen  has,  however, 
been  found  in  the  urethra  where  none  was  ejected  externally.' 

Third  stage:  All  is  quiet  except  the  beating  of  the  heart. 
As  a  rule,  the  pulse  may  be  felt  for  ten  minutes. 

Blankenship  ^  rejjorts  an  execution  of  a  man  by  hanging.  After 
the  rope  was  adjusted  the  jjulse  was  121 ;  fu'st  minute  after  droji,  pulse 
54  ;  second  minute  52  ;  third  39  ;  fourth  20  ;  fifth  0  ;  sixth  70  ;  seventh 
73  ;  eighth  0  ;  ninth  34  ;  not  perceptible  afterward.  Died  from  stran- 
gulation ;  neck  not  dislocated.  The  heart  beat  once  in  the  nineteenth 
minute  ;  from  the  ninth  to  the  nineteenth,  only  two  or  three  times.  No 
priapism. 

In  judicial  executions,  however,  the  right  auricle  is  found  in 
action  when  the  subject  is  taken  down  at  the  end  of  the  usual 
period  of  suspension  (see  Case  89).  Tardieu  mentions  a  case 
where  the  heart  was  beating  80  to  the  minute  one  and  one-half 
hours  after  supposed  death.  It  is  probable  that  in  these  cases 
the  deprivation  of  air  and  compression  of  the  vessels  has  not 
been  complete.  In  such  cases  life  may  sometimes  be  restored. 
Cases  are  reported  where  restoration  has  been  possible  within  a 
period  of  a  half-hour  of  suspension ;  although  the  fatal  period  is 
usually  five  to  eight  minutes  at  most.  If,  however,  the  tissues 
and  especially  the  spinal  cord  are  injured,  or  the  ligature  has 
compressed  below  the  larynx,  the  chance  of  recovery  is  very 
small,  even  if  the  body  is  cut  down  at  once.  According  to 
Faure,  animals  experimented  upon  die  in  twelve  to  twenty 
minutes. 

Many  cases  of  "incomplete"  hanging  have  been  reported; 
where  the  feet  touch  the  floor,  or  would  do  so  if  the  subject 
should  choose  to  have  it  so.     Tardieu  ^  collected  261  cases,  in 

^  See  articles  of  Huppert.    Vier.  *  Jour.  Amer.  Med.  Assn.,  1885,  i., 

ger.   Med.,  etc.,  xxiv.,  pp.   237-252,  p.  658. 

and   Miiller-Beninga,    Berlin,  klin.  ^  "Pend.,"  etc. ,  p.  22. 
Woch..  1877,  xiv.,  p.  481. 


SYMPTOMS   IN   HANGING. 


743 


168  of  which  the  feet  touched  the  ground,  in  42  the  subject  was 
on  his  knees,  in  29  the  body  was  hnng,  in  29  sitting  and  in  3 
squatting.  Hackel,'  in  07  cases  of  hanging,  found  it  incomplete 
in  34  per  cent. 

In  one  of  the  experiments  of  Faure  -  a  large  clog  was  hving,  his  feet 
touching  the  ground.     For  five  minutes  he  was  quiet,  breatliing  with- 


FiG.  22.— Suicide  of  Prince  Cond6.    (See  page  763.) 

out  difficulty.  He  then  tried  to  release  himself,  but  instead  tightened 
the  knot ;  he  made  still  greater  efforts  to  release  himself,  became  com- 
atose and  fell,  apparently  dead,  at  the  end  of  ten  minutes ;  was  really 
dead  in  twenty-eight  minutes. 

In  incomplete  hanging  the  upper  limbs  maj'  have  anj'-  posi- 
tion ;  the  lower  limbs  are  disposed  according  to  the  position  of 
the  body  (Cases  1,  10,  18,  19,  20,  22,  24,  20,  28,  37,  43,  50,  50). 


'  Dorpat  Diss. ,  1891. 


-Arch.  gen.  de  Med.,   1856,  vii., 
p.  315. 


744  HANGING — LAMB. 

Faure  '  made  many  observations  on  dogs  which  he  killed  by  hang- 
ing. He  describes  the  results  as  follows  :  The  dog  remains  quiet  usu- 
ally twenty  to  thirty  seconds,  sometimes  eight  to  ten  minutes;  then 
becomes  violently  agitated,  the  body  being  thro^\na  forward  and  back- 
ward so  powerfully  that  it  bounds  to  a  great  height ;  the  head  is  in 
motion ;  the  jaws  i^arted ;  the  feet  extended  and  flexed ;  sometimes 
brought  up  to  the  mouth  and  neck,  trying  to  remove  the  obstruction ; 
the  inside  of  the  mouth  is  ^'iolet-colored ;  tongue  blackish,  livid,  may 
be  bitten,  often  falls  backward ;  the  teeth  are  ground  together ;  the 
eyes  sometimes  protrude ;  conjunctivae  congested  ;  urine  and  faeces 
discharged.  The  agitation  lasts  two  to  five  minutes,  and  then  the  dog 
gradually  becomes  quiet.  Toward  death,  however,  the  agitation  is 
renewed  but  in  a  different  way ;  the  fore-feet  are  raised  and  put  for- 
ward, the  tongue  often  has  a  peculiar  spasm,  the  chest  is  raised,  the 
eyes  drawn  back  into  the  orbits,  pupils  contracted ;  all  of  tliis  is  over 
within  two  seconds.  Such  paroxysms  may  be  repeated  half  a  dozen 
times.  In  dji^ng,  the  eye  oscillates  from  side  to  side  and  the  pupil 
dilates.     The  heart  beats  some  time  longer. 

Francis  Bacon  records  that  he  knew  a  man  who  wanted  to  find  out 
by  experience  if  there  was  any  suffering  in  hanging.  He  placed  the 
cord  around  his  neck  and  stepped  off  a  bench,  intending  to  step  back 
again,  but  became  immediately  unconscious  and  would  have  died  but 
for  the  opportune  arrival  of  a  friend.  He  said  he  saw  a  light  before  liis 
eyes. 

Treatment. 

The  first  indications  obviously  are  to  let  the  subject  down, 
and  remove  all  constriction  of  neck  and  chest.  Artificial  respi- 
ration should  then  be  used,  and  this  may  be  assisted  hj  the 
vapor  of  ammonia  to  the  nose  and  tickling  the  fauces.  If  the 
body  is  warm,  cold  affusions  may  be  applied  to  the  head  and 
chest,  and  galvanism  may  be  used. 

If  the  body  is  cold,  apply  warmth.  Friction  of  the  limbs 
aids  in  restoring  warmth.  If  the  subject  can  swallow  give 
stimulants;  these  may  also  be  used  by  rectum.  Venesection 
may  be  required  to  relieve  cerebral  congestion  or  distention  of 
the  right  heart  and  pulmonary  circulation. 

The  following  cases  illustrate  what  may  be  done  to  resuscitate  one 
who  has  been  hanged:  A  man,  age  35,  in  good  health,  weight  one  hun- 
dred and  sixty  pounds,  was  executed  with  a  drop  of  over  six  feet;  the 
rope  slipped  behind  the  mastoid  process.     After  thi-ee  minutes  liis  strug- 

1  Op.  cit. ,  p.  308. 


TREATMENT.  745 

gles  ceased;  the  radial  beat  ceased  at  six  and  one-half  minutes;  all  signs 
of  life  at  ten  and  one-half  minutes,  aad  the  body  was  bhie.  Fourteen 
and  one-half  minutes,  body  let  down;  mark  about  one-fourth  inch  deep 
on  neck;  swelling  above  and  below;  no  fracture  of  vertebra^.  Strong 
galvanism  of  the  pneuinogastrics  after  sixteen  or  seventeen  minvites  at 
intervals  of  four  seconds  caused  marked  respiratory  efforts;  sixty -six 
minutes,  galvanism  renewed;  heart-beat  and  radial  pulse  recognized; 
epiglottis  swollen,  requirmg  the  tongue  to  be  dra^^^l  forward;  a  few 
ounces  of  blood  removed;  jjupils  contracted.  One  hundred  and  four 
minutes,  galvanism  renewed;  subject  swallowed  a  little  brandy-and- 
water.  One  hundred  and  thirteen  minutes,  slight  muscular  action; 
cornea  sensible.  One  hundi'ed  and  eighty -six  minutes,  feet  warm,  car- 
otid pulsation.  Signs  of  life  now  increased  till  six  hours  after  drop, 
when  pupils  began  to  dilate  again.  Twelve  to  fifteen  ounces  of  blood 
were  taken  and  pupils  again  contracted  and  pulse  beat  sti-ong  and 
steady;  breathing  easy,  more  regular;  eyes  followed  movements  of  per- 
sons around  the  room.  Died  nine  hours  later,  fifteen  hours  after  drop. 
The  experiments  were  repeatedly  interrupted  by  the  sheriff. '  Taylor  * 
reports  a  case  of  recovery.  Woman,  age  44;  found  hanging  from  a 
clothes-line,  thro^Ti  over  a  door  and  fastened  to  a  handle  on  the  other 
side;  her  knees  on  the  floor;  white  froth  around  the  mouth;  tongue 
protruding  and  swollen;  face  dusky  and  swollen;  lips  dark  bhie;  brown 
parchment  mark  on  neck;  skin  abraded  over  larynx;  conjunctiva  in- 
sensible; pupils  dilated  and  fixed;  fingers  clinched;  limbs  flaccid;  no 
reaction  from  tickling  feet;  no  respiration;  faint  heart-beat  and  fine 
thready  jjulse.  Sj-lvester's  artificial  respiration  method  used  at  once 
and  continued  for  four  and  one-half  hours;  tongue  held  forward  by 
forceps.  One  hundred  and  fifteen  minutes  after  body  was  first  seen 
there  was  spontaneous  movement  of  legs.  One  hiindred  and  forty-five 
minutes,  conjitnctivas  sensible.  One  hvmdi'ed  and  seventy-five  min- 
utes, retching.  Two  hundred  and  five  minutes,  free  vomiting.  She 
recovered  but  remembered  nothing  of  the  hanging.  Keen  ^  reports  the 
results  of  experiments  upon  a  criminal  who  was  executed  by  hanging. 
He  was  cut  down  about  half  an  hour  after  the  drop.  Fai'adization  and 
galvanization  of  pneumogastric  and  recurrent  laryngeal  nerves  caused 
movements  of  left  vocal  cord,  but  not  the  right ;  there  was  no  reflex 
motion  in  the  larjTix.  The  left  phrenic  nerve  made  no  response  to 
stimulus.  The  internal  intercostal  nerves  caused  the  raising  of  the  car- 
tilage below  them  (iusj^iratory),  the  external  intercostals  dejjressed  the 
iipper  seven  ribs  (expiratory),  and  i-aised  the  eighth.  The  other  four 
not  examined.     The  muscles  of  the  face  retained  their  contractihty. 

Very  few,  comparatively,  however,  have  been  restored  after 
hanging.     For    cases    of    recovery  see    Medical   Times  and 

'Lancet,  1871,  11.,  p.  98.  [387.  ^ pjjiiadelphia    Medical     Times, 

^  Glasgow  Med.  Jour. ,  1880,  xiv. ,  p.        1875. 


746  HANGING — LAMB. 

Gazette,   London,   1871,  Vol.   I.,  p.   OGO  (Cases  12,  13,  42,  44, 
47,  49,  GG). 

PosT-MoRTEM  Appearances. 

The  post-mortem  appearances  are  external  and  internal. 

The  external  appearances  are  those  due  to  the  action  of  the 
ligature  on  the  neck  and  to  other  violence,  if  any  has  been 
done,  and  those  due  to  asphyxia  or  syncope. 

The  MARKS  of  the  ligature.  If  the  suspension  be  very  brief 
and  the  ligature  soft  and  supple,  and  the  body  instantly  cut  clown 
after  death,  there  may  be  no  mark.  Allison  '  questions  the  value 
of  the  mark,  contending  that  it  is  post  mortem,  and  reports  cases ; 
says  it  is  present  only  if  the  drop  be  considerable  or  the  sus- 
pension continue  after  death.  Tidy  says  that  the  mark  is,  in  a 
measure,  independent  of  the  ligature  and  duration  of  suspen- 
sion, and  does  not  usually  acquire  its  color  for  some  hours  after 
death ;  sometimes,  however,  it  has  occurred  in  a  much  shorter 
time.  It  may  be  slight  because  the  ligature  has  been  placed 
over  the  clothing.  The  longer  a  body  hangs  after  death,  the 
more  the  mark  shows.     It  can  be  produced  upon  the  cadaver. 

Harvey  ^  says :  "  The  characteristic  mark  is  sometimes  found 
in  non-fatal  cases.  ...  In  eight  instances  in  the  present  re- 
turns (of  nearly  1,500  cases  of  hanging)  there  was  a  distinct 
mark." 

Coutagne,  ^  in  twenty-four  necroscopies  on  subjects  hung,  found 
only  slight  or  doubtful  lesions  in  five  cases  ;  but  of  these,  one  was  in  a 
condition  of  advanced  putrefaction,  another  was  apparently  weakened 
by  loss  of  blood  from  wounds,  and  in  the  other  three  there  were  marks 
of  violence.  In  seventeen  cases  the  lesions  of  the  neck  were  plain; 
hemorrhage  in  connective  tissue  or  muscle. 

The  direction  of  the  mark  is  usually  oblique,  following  the 
line  of  the  lower  jaw  upward  and  backward  behind  the  mastoid 
processes ;  it  maj^,  however,  be  horizontal.  If  the  ligature  en- 
circles the  neck  more  than  once,  one  mark  may  be  circular,  the 
other  oblique.  If  a  running  noose  is  used  the  mark  may  be 
circular,  and  be  seen  all  the  way  around  the  neck,  looking  like 
the  mark  of  a  strangulation.     Taylor  *  states  that  if  the  noose 

'Lancet,  1869,  1.,  p.  636.  ^  Op.  cit.,  p.  245. 

'Indian  Med.   Gaz.,   1876,   xi.,  p.  -"'Med.   Jur.,"  Am.  ed.,  1892,  p. 

29.  398. 


POST-MORTEM   APPEARANCES.  *      747 

should  be  in  front,  the  mark  may  be  circular,  the  jaw  prevent- 
ing the  ligature  from  rising  upward  in  front  as  much  as  it  does 
behind.  If  it  encircles  the  neck  but  once,  its  continuity  is  apt 
to  be  broken  by  the  prominence  of  the  hyoid  bone,  thyroid  car- 
tilage, sterno-mastoid  muscles,  etc. 

In  four-fifths  of  the  cases  (117  out  of  143,  Tardieu)  the  mark 
is  found  between  the  chin  and  larynx;  in  nearly  all  the  re- 
maining fifth,  over  the  larynx;  in  a  very  few  below  the  larynx; 
the  last  position  is  due  to  the  protection  of  the  neck  by  a  hand- 
kerchief or  beard,  or  where  there  is  some  anatomical  or  patho- 
logical peculiarity  which  prevents  the  ligature  from  going 
higher. 

Hofmann '  had  seen  two  cases  of  tumor  of  neck  ;  one  in  a  woman, 
where  the  cord  was  below  the  larynx;  and  in  a  man  where  it  was 
over  the  larjTix.  He  quotes'^  as  follows:  Remer,  above larjTix,  38; 
over  larynx,  7;  below  larjTix,  2.  Devei'gie,  above  larjTix,  20;  over 
larynx,  7;  below  larATix,  1.  Casper,  above  larynx,  59;  over  larynx,  9. 
Rotli  ^  in  49  cases  found  the  ligature  mark  above  the  hyoid  bone  in 
5;  between  the  bone  and  the  larynx,  31;  over  the  larjTix,  8;  below 
the  larynx,  1.  Hackel  found  the  ligature  in  forty  per  cent  of  cases 
between  hyoid  bone  and  larj-nx;  in  sixty  per  cent  lower  down.  The 
ligature  alwaj's  appears  lower  after  the  body  is  laid  down  than  it  was 
in  suspension.  Maschka  found  the  furrow  147  times  in  153  cases  above 
the  lainnix. 

The  mark  will  vary  in  character  according  to  the  kind  of 
ligature  used,  its  mode  of  application,  the  vitality  of  the  tissues, 
and  the  period  that  has  elapsed  since  death.  The  result  is  dif- 
ferent according  as  the  knot  or  loop  is  single  or  double,  a  run- 
ning or  slip  knot. 

The  mark  may  differ  in  character  in  one  part  of  the  neck 
from  another.  The  same  furrow  may  be  soft  in  one  part  and 
dry  in  another.  The  width  of  the  mark  does  not  necessaril}^ 
correspond  to  the  diameter  of  the  ligature.  A  double  mark 
usually  means  that  the  ligature  has  been  twice  passed  around 
the  neck,  although  the  marks  may  not  be  continuous  or  parallel. 
Tardieu  states  that  a  large  single  leather  thong  pressing  on  the 
neck  only  by  its  borders  ma}'  make  a  double  mark.  The  mark 
is  usuall}'  depressed.     The  depth  of  the  depression,  groove,  or 

'Op.  cit.,  p.  523.  "Deutsch.  Archiv  f.  Staats,  1870, 

"^  Op.     cit.,     Levy's     translation,      xxviii.,  p.  1313. 
1881,  p.  363. 


748  HANGING — LAMB. 

furrow,  as  it  is  called,  is  greater  the  narrower  and  firmer  the 
ligature,  the  longer  the  suspension,  and  the  greater  the  weight 
of  the  body.  The  mark  may  be  merely  a  slight  depression, 
without  color,  or  only  a  red  blush,  if  the  subject  is  young, 
tissues  healthy,  and  suspension  brief.  Roth,'  in  49  cases  of 
hanging,  found  the  furrow  of  the  ligature  was  brown  in  40,  red- 
brown  in  6,  and  3  times  bluish. 

In  about  two-thirds  of  the  cases  the  bottom  of  the  furrow, 
the  place  of  greatest  pressure,  is  white,  especially  so  where  the 
knot  is  tied ;  while  the  edges  of  the  furrow  are  usually  slightly 
raised  and  red  or  livid.  If  the  subject  is  verj^  fat,  there  may 
be  only  a  slight  depression.  Harvey"  says  that  this  hard, 
white,  shining,  translucent  band  from  compression  of  the  con- 
nective tissue  is  the  first  stage  of  the  parchment  or  vellum  skin, 
and  is  chiefl}"  noticed  in  fresh  bodies.  The  borders  are  swollen 
and  oedematous,  called  by  Lacassagne  "  bourrelet  de  sillon." 

The  skin  beyond  the  furrow  is  usually  violet.  Authors 
differ  as  to  whether  this  is  due  to  congestion  or  hemorrhage. 
Roth  ^  in  49  cases  found  swelling  below  the  furrow  27  times. 
Hackel  found  ecchymoses  above  the  mark  in  thirty -five  per  cent 
of  the  cases  of  hanging.  Hofmann  thinks  that  the  lividity  of 
the  upper  border  of  the  furrow  is  due  to  the  stopping  of  the 
venous  blood  descending  from  the  head. 

The  drj",  hard,  yellowish-brown,  or  reddish-brown  "  parch- 
ment" furrow,  described  by  writers,  is  said  to  be  common. 
Ogston  ^  found  it  in  one-third  of  his  cases.  It  is  found  onl}' 
when  the  body  has  remained  suspended  for  several  hours  after 
death;  indeed,  may  be  produced  by  applying  the  ligature  to 
the  cadaver ;  is  not  at  all,  therefore,  a  proof  of  suspension  dur- 
ing life.  Liman  states  that  constriction  by  a  ligature  even  for 
some  time  does  not  necessarily  cause  a  mummified  or  excoriated 
furrow.  He  saw  cases  in  which  the  mark  was  soft,  flat, 
scarcely  colored,  but  little  interrupted,  and  not  parchmenty. 
The  parchment  skin  seems  to  depend  very  much  upon  a  pre- 
vious excoriation  of  the  skin.  Its  appearance  can  be  prevented 
or  delayed  by  examining  a  body  soon  after  death  or  by  rehang- 
ing  it ;  and  after  it  has  appeared  it  will  disappear  on  the  appli- 
cation of  some  liquid.     Taylor  ^  compares  this  parchment  mark 

'  Op.  cit.,  p.  281.  3  Op.  cit..  p.  287. 

'-'Indian  Med.  Gaz.,   1876,   xi.,  p.      ^"Med.  Jur.,"p.  527. 
39.  5  "  Med.  Jur. , "  Am.  ed. ,  1892,  p.  399. 


POST-MORTEM   APPEARANCES.  Ti9 

to  the  otitis  from  which  the  cuticle  has  been  removed  for  two 
or  three  days. 

Slight  abrasions  and  ecchymoses  are  sometimes  found  in  the 
furrow.  Ecchymoses  alone  do  not  indicate  whether  suspension 
has  been  before  or  after  death ;  but  abrasions  with  hemorrhage 
strongly  suggest  suspension  during  life.  Devergie  regards 
ecchymoses  of  the  neck  as  strongly  suggestive  of  homicide. 
Neyding '  says  that  suggillation  in  the  groove  is  oftener  found 
in  strangulation  than  hanging.  And  Bremme  ^  that  there  is  no 
hemorrhage  in  the  subcutaneous  tissue  of  the  mark  if  death 
occurs  at  once  and  the  cord  is  removed  at  once  after  death ; 
but  if  the  cord  remains  for  some  time  after  death  there  may  be 
hemorrhage,  or  if  death  does  not  occur  at  once,  whether  the 
ligature  be  removed  or  not. 

Roth  ^  found  ecchj'moses  or  small  bladders  at  the  lower  mar- 
gin of  the  furrow,  9  times  in  -iO  cases.  Riechke  found  only 
once  in  30  cases  a  hemorrhage  beneath  and  on  both  sides  of  the 
mark.  Chevers  did  not  find  ecchymoses  of  the  skin  of  the  mark 
in  cases  of  hanging.  Casper  found  no  ecchymoses  in  50  of  71 
cases.  Maschka  has  seen  two  cases  where  burns  on  the  neck 
resembled  mark  of  ligature. 

The  furrow,  when  once  distinct,  remains  constant  for  a  long 
time  after  death,  even  in  putrefaction.  Marks  from  soft  sub- 
stances, however,  disappear  sooner  than  those  from  strong  and 
uniform  compression. 

The  NECK  nearly  always  appears  stretched.  According  to 
Roth  the  mobilit}^  of  the  head  is  increased  by  this  stretching. 
The  HEAD  is  always  inclined  to  the  opposite  side  to  that  of  the 
knot.  In  suicides  the  head  is  usually  bent  forward  on  the 
chest.  The  hands  are  often  clinched  so  tightly  that  the  nails 
are  driven  into  the  palms.  This  occurs  more  especially  when 
the  hanging  has  been  done  with  violence.  When  the  feet  touch 
the  ground,  as  often  occurs  in  suicide,  the  hands  may  be 
stretched  out.  Roth  found  the  hands  and  feet  flexed  in  44  of 
49  cases.  Taylor  says  that  we  maj'  expect  to  find  the  hands 
clinched  when  constriction  of  the  neck  is  sudden  and  violent. 
The  LEGS  are  usually  livid. 

The  FACE  varies  with  the  duration  of  the  suspension;  at 
first  it  is  pale,  afterward  livid ;  congested  and  swollen,  if  the 

'Vier.    f.    ger.    Med.,    1870,    xii.,        277,     ;lg70.  xiii.,  pp.  247-260. 
pp.  340-369.  ^Oj).  cit.,-p.  281. 


750  HANGING — LAMB. 

subject  has  been  long  suspender! .  Roth  found  the  face  pale 
in  43  of  49  cases.  In  about  one-half  the  cases  the  features 
are  calm  and  placid  (syncope) .  Maschka  found  the  lips  bluish 
in  98  of  153  cases.  The  eyes  are  often  prominent,  staring, 
and  congested,  and  usually  the  pupils  are  dilated.  Lacassagne 
and  Maschka  '  look  upon  ecchymoses  of  the  eyelids  and  conjunc- 
tivse,  '^ piquete  scarlatin"  as  important  as  favoring  the  idea  of 
hanging  or  strangulation.  Roth  found  in  49  cases  the  eyelids 
closed  28  times;  half  open,  12;  congested  in  6;  ecchymosed  in 
2.  Pupils  dilated  in  31 ;  narrowed  in  2,  Dilated  in  97^  per 
cent  of  Ogston's  cases  (Cases  85,  86;  rupture  of  crystalline 
lens).  Harvey^  says  the  blood  was  found  flowing  from  the 
EAR  in  G  cases  of  nearly  1,500,  but  no  details  were  given, 
Ogston,  one  case.  Hofmann  saw  a  case  in  which  there  was 
bleeding  from  the  ears.  He  says  this  is  not  due,  as  has  been 
supposed,  to  rupture  of  the  t3^mpanic  membrane,  but  to  hemor- 
rhage from  subcutaneous  vessels  (Case  27). 

The  TONGUE  is  usually  livid  and  swollen,  especially  at  the 
base.  According  to  Tidy,  Dr.  Guy  looks  on  this  as  showing 
that  suspension  took  place  very  probabl}"  during  life.  In  about 
one-third  of  the  cases  the  tongue  is  protruded  and  compressed 
between  the  teeth ;  sometimes  bitten.  Some  observers  found  it 
protruded  only  as  a  result  of  putrefaction.  The  protrusion  of 
the  tongue  is  not  believed  to  depend  on  the  position  of  the  liga- 
ture. Hackel  in  67  cases  found  the  tongue  lying  forward  in 
all  cases  where  the  cord  was  between  the  larynx  and  the 
hyoid;  in  55  per  cent  in  front  of  the  teeth,  in  18  per  cent 
between  the  teeth;  where  the  ligature  was  lower  down,  the 
tongue  was  behind  the  teeth.  He  found  by  experiment  that  in 
the  spasmodic  expiratory  effort  the  tongue  was  thrust  forward ; 
in  the  inspiratory  movement,  drawn  backward.  He  concluded 
that  the  forward  movement  was  the  result  of  reflex  action. 
Maschka  ^  found  the  tongue  between  the  teeth  58  times  in  149 
cases.  Roth  in  49  cases  found  the  tongue  projecting  and  bit- 
ten in  22,  the  teeth  shut  in  15  others;  in  15  the  mouth  was 
open ;  the  tongue  was  retracted  in  30  cases. 

Harvey,   after  examining  reports  of  nearly  fifteen  hundred  hang- 
ing's, says:  "In   the    majority  of  instances  innnediately  after  death 

iPellier,  op.  cit.,  p.  83.  ^"Handbuch,"  p.  571. 

nnd.  Med.  Gaz.,  1876,  xi.,  p.  30. 


POST-MORTEM   APPEARANCES.  751 

the  features  were  placid,  the  face  pale,  the  eyes  not  undvily  i)rom- 
inent,  the  mouth  closed  or  half  open,  the  tongue  pressed  against  the 
teeth  but  not  protruding;  the  suijerficial  veins  full,  but  the  head,  neck, 
and  trunk  free  from  lividity.  After  a  longer  or  shorter  time,  however, 
and  apparently-  after  a  very  few  hours,  in  India,  all  this  is  changed. 
Livid  patches  appear  about  the  chest,  back,  and  shoulders;  the  face  and 
head  become  bloated  and  pufpy,  the  tongue  and  eyes  ]>rotrude." 

Bloody  froth  is  sometimes  seeu  at  the  nose  and  mouth. 

Saliva  is  invariably  secreted  and  run§  out  of  the  mouth 
down  on  the  chin  and  chest.  Its  presence  is  considered  as  evi- 
dence that  suspension  occurred  during  life.  The  urine  and 
F^CES  are  sometimes  found  to  have  been  expelled.  These  dis- 
charges occur  in  all  kinds  of  violent  death.  Tardieu  found 
them,  however,  but  twice  in  41  cases  of  hanging.  Roth 
in  49  cases  found  discharges  of  faeces  in  17  and  urine  in  4;  in 
15  cases  not  noticed. 

Harvey  mentions  a  case  where  internal  piles  had  burst,  and 
there  were  stains  and  clots  of  blood  about  the  perineum  and 
anus.  In  such  cases  without  careful  examination  there  would 
naturally  be  a  suspicion  of  violence. 

In  about  one-fourth  of  the  cases  the  genital  organs  are 
congested.  The  penis  is  large  and  more  or  less  erect;  seminal 
fluid,  generally  prostatic,  and  sometimes  mixed  with  blood,  is 
often  expelled.  The  fluid  maj"  pass  only  into  the  urethra  and  it 
may  be  necessary  to  press  the  urethra  to  secure  it.  The  clitoris 
may  be  found  erect,  and  there  ma}'  be  a  sort  of  menstrual  flow. 
Orfila  showed  by  experiment  that  swelling  of  the  sexual  or- 
gans and  emission  of  semen  can  be  produced  after  death  in 
those  who  had  been  suspended  during  life.  The  flow  of  semen 
is  found  in  all  kinds  of  death  by  violence.  Roth  in  39  cases  of 
hanging  of  men  found  the  penis  enlarged  18  times  and  ejacula- 
tion in  19.  Hackel  found  the  penis  swollen  in  43  per  cent  of 
cases  of  asphyxia.  Erection  may  come  on  soon  or  late,  even 
daj'S  after  death. 

Internal  Appearances. — The  connective  tissue  under 
THE  MARK  is  usually  white  and  condensed,  the  more  so  if  the 
body  has  been  long  suspended.  This  dryness  or  condensation 
was  found  by  Hackel  in  52  per  cent  of  hangings.  Deeper-seated 
parts  are  injured  only  when  the  hanging  has  been  violently 
done.     The  muscles,  especially'-  the  sterno-mastoid,  are  some- 


752  HANGING — LAMB. 

times  ruptured.  Hofmann  '  reports  several  cases.  Lesser'^  in 
50  hangings  saw  11  ruptures  of  muscle.  Maschka  never  saw 
the  rupture  in  suicides.  The  sterno-mastoid  was  ruptured  in 
the  case  of  Wirtz  (Case  96)  and  Guiteau  (Case  95).  Hackel 
in  67  cases  failed  to  find  the  muscle  ruptured.  Hofmann^ 
believes  that  the  rupture  of  the  muscle  is  sometimes  post 
mortem.  Coutagne  ^  found  the  sterno-mastoid  muscle  ruptured 
once  in  24  cases  (Cases  29,  89,  95,  96). 

The  LARYNX  may  be  fractured  or  dislocated.  These  lesions 
are  very  rare  in  suicide ;  more  frequent  in  homicide  and  judicial 
hanging,  and  in  the  old  where  the  cartilages  are  calcareous. 
Remer  found  the  injury  in  but  1  case  in  101  of  suicidal 
hanging.  Barker  found  the  larynx  lacerated  in  his  judicial 
cases.  ^  Harvey  says  that  the  trachea  was  reported  lacerated 
11  times  in  nearly  1,500  cases;  twice  the  laryngeal  cartilages 
were  separated  from  each  other.  In  5  these  cartilages  were 
fractured,  but  there  was  nothing  to  show  under  what  conditions. 
Hemorrhage  in  vicinit}'  of  larynx,  43  times.  Pellier "  reports  1 
case,  and  adds  that  the  existence  of  the  lesion  easily  escapes 
notice  because  of  the  mobility  of  the  cornua.  Roth  in  49  cases 
failed  to  find  any  fracture.  Pellier  found  the  cricoid  was  in- 
jured often er  than  the  thyroid,  which  is  the  reverse  of  what  is 
found  in  strangulation.  Cavasse '  was  unable  to  cause  fracture 
of  larynx  by  hanging  the  cadaver.  Chailloux*  collected  6  cases 
of  fracture  of  larynx  in  hanging.  He  concluded  that  the  frac- 
ture could  not  be  produced  on  the  cadaver  by  hanging,  and  is, 
therefore,  caused  during  life.  Coutagne'  in  24  cases  found 
fracture  of  thyroid  cartilage  8  times  (Cases  9,  51,  82). 

The  HYOID  BONE  is  rarely  dislocated.  Orfila  mentions  a 
case  of  fracture.  Barker  found  the  bone  usually  fractured  in 
judicial  cases.  In  the  case  of  Wirtz  {supra)  the  greater  comu 
was  broken.  Pellier  reports  2  cases.  Hofmann '°  saj^s  the 
hyoid  cornua  are  often  fractured,  especiallj"  when  the  ligature 
is  between  the  hyoid  bone  and  thyroid  cartilage.     Coutagne 

'Wien.    med.   Presse,    1881-1882,  ^  See  Brit,  and  For.  Med.  Rev.,  ii., 

xxii.,  p.  1533.  p.  214. 

2  Vier.  f.  ger.  Med.,  1881,  xxxv.,  ^  Op.  cit..  p.  98. 

p.  201.  '  Paris  thesis,  1859,  No.  9. 

»Lehrbuch,  p.  532.  « Paris  thesis,  1874,  No.  291. 

*0p.  cit.,  p.  245.  ^Op.  cit.,  p.  245. 

'«0p.  cit.,  p.  533. 


INTERNAL   APPEARANCES.  753 

found  fracture  of  hyoid  bone  8  times  in  24  cases.  He  attributed 
the  fracture  to  pressure  against  the  spine.  Pellier  speaks  of 
fracture  of  styloid  process  (Cases  51,  84,  88,  89,  05,  06). 

Dr.  Barker,  of  Melbourne/  states  that  in  50  cases  of  lianging 
by  the  old  method  there  was  not  on<  case  ol  fracture  or  dislo- 
cation of  vertebrce.  After  adopting  his  suggestion  to  place 
the  knot  near  the  spine,  he  found  that  dislocation  occurred  be- 
tween the  second  and  third  cervical  vertebrae  with  fracture  of 
the  third  and  pressure  on  the  spinal  cord.  Death  was  sudden 
and  complete.  The  drop  in  these  cases  was  short,  three  to  four 
feet.  Coutagne  thinks  that  the  ordinary  mobility  of  the  head, 
axis,  and  atlas  on  each  other  have  led  reporters  into  the  mistake 
of  supposing  a  dislocation  of  vertebrae.  Roth  failed  to  find  frac- 
ture of  vertebrae  in  any  of  40  cases.  These  injuries  are  espe- 
cially rare  in  suicide;  but  in  violent  hanging,  dislocation  or 
fracture  may  occur  and  also  rupture  of  the  ligaments.  Harvej' 
gives  5  cases  of  dislocation  of  vertebra  and  4  of  fracture  of 
vertebra  in  suicides.  Three  of  tlie  latter  were  doubtful.  Tar- 
dieu  says  these  fractures  have  no  significance  as  to  the  hanging 
having  occurred  during  life.  They  can  bo  produced  on  the 
cadaA^er;  but  infiltration  of  clotted  blood  around  injured  verte- 
brae shows  that  suspension  occurred  during  life  (Cases  5,  7,  8, 
68,  76  to  70,  83,  84,  01,  02,  04).' 

The  CAROTID  ARTERIES  may  be  injured ;  usually  the  inner 
and  middle  coats  are  torn ;  and  hemorrhage  may  occur  into  the 
wall  of  the  vessel.  The  common  carotids  are  the  ones  usuallj^ 
affected,  and  just  below  the  bifurcation,  but  the  external  is  also 
occasionall}^  injured.  The  injury  is  said  to  be  due  to  the 
stretching  and  squeezing  of  the  artery,  stretching  being  the 
most  effective  since  the  rupture  often  occurs  at  a  distance  from 
the  mark  of  the  ligature.  Such  injury  of  the  artery  does  not 
prove  that  hanging  took  place  during  life  because  it  has  been 
produced  on  the  cadaver;  but  hemorrhage  into  the  wall  of  the 
vessel  or  wound  or  rupture  after  death  is  very  improbable. 
Maschka  saj^s  the  lesion  is  ver}^  rare.  Tardieu  says  that  the 
injury  to  the  carotid  is  rare  and  therefore  unimportant.  Pellier 
reports  4  cases  of  rupture  of  carotid  in  a  total  of  23.  Levy 
records  the  experiments  of  Hofmann,  of  Vienna,  and  Brouardel 

'Med.  Times  aud  Gaz.,   1871,  i.,  -LvouMed.,  1883.  xliv.,  p.  11. 

p.  071. 

48 


754  HANGING — LAMB. 

and  himself,  of  Paris,  5  in  number.  He  concluded  that  com- 
pression of  the  carotid  arteries,  if  it  produces  obliteration,  can 
cause  rapid  loss  of  consciousness  and  death ;  and  explains  why 
in  incomplete  suicide  the  subject  is  unable  to  help  himself. 
Coutagne  found  rupture  of  carotids  10  times  in  24  cases.  He 
insists  on  the  importance  of  the  lesion. 

Hofmann  '  says  the  I'upture  is  always  transverse,  may  be  simple  or 
multiple  and  may  occm'  in  suicides;  more  apt  to  occur  when  the  liga- 
ture is  thin.  Lesser^  tabulated  50  fatal  cases  of  suicidal  hanging;  in 
29,  he  was  satisfied  that  the  lianging  occurred  during  life.  In  3  of  these 
the  skin  of  the  neck  alone  showed  any  lesion;  there  was  a  double  mark, 
the  skin  being  otherAvise  bloodless.  In  5  the  deeper  soft  jjarts  were  the 
only  ones  affected.  In  3  the  skin  showed  lesions,  the  deeper  soft  parts 
none,  but  either  the  hyoid  bone,  larynx,  or  vertebrse  were  involved. 
In  12  the  skin  showed  no  mark,  but  the  deeper  soft  parts  and  either 
the  larynx  or  hyoid  bone  were  involved;  and  in  6  the  hyoid  bone  only 
or  the  bone  and  larynx  were  injured.  In  the  remaining  cases  it  was  not 
possible  to  say  that  the  hanging  occurred  during  life.  In  2  cases  there 
were  no  marks  at  all ;  in  9  there  were  changes  in  the  skin  ;  in  4, 
changes  in  the  skin  and  deeper  parts;  in  2,  changes  in  the  skin,  deeper 
parts,  and  hyoid  bone  or  larynx;  in  3,  changes  in  the  skin  and  hyoid 
bone  or  larynx,  or  both.  In  14  of  the  50  cases  the  hyoid  bone  was 
fractured ;  in  20  the  larynx;  and  in  1  the  vertebrae.  The  common  car- 
otid arteries  were  injured  in  6.  The  number  and  severity  of  the  le- 
sions bore  no  constant  relation  to  the  thickness  of  the  ligatiu'e,  nor  to 
the  force  vised,  but  rather  to  the  position  of  the  body. 

Ecker  ^  reported  a  case  of  suicidal  hanging  in  a  man,  age  40,  where 
the  soft  palate  was  swollen  and  filled  up  the  passage  so  that  the  air 
evidently  could  not  enter. 

The  LARYNX  and  the  trachea  are  usually  deeply  con- 
gested, of  a  red  color;  a  violet  color  indicates  putrefaction. 
Ogston  reports  mucus  but.  not  bloody  froth  9  times  in  the 
pharynx,  6  in  the  trachea,  and  4  in  the  lungs,  in  a  total  of  40 
cases.  In  one  case  there  was  a  quantity  of  blood  in  the  larynx 
and  pharynx.  Taylor  thinks  that  pinkish  froth  in  the  trachea 
indicates  incomplete  obstruction ;  and  Chevers  that  it  is  due  to 
spasmodic  efforts  to  breathe  when  the  obstruction  is  nearly 
complete.  Chevers  always  found  clear  mucus  in  the  larynx  and 
upper  part  of  trachea,  each  follicle  being  marked  by  a  minute 

'  Lehi-buch,  p.  535.  ^Virchow's  Archly,    1870,    xlix., 

-  Vier.  f.  ger.  Med.  imd  off.  San.,      p.  290. 
1881,  XXXV.,  pp.  201-248. 


INTERNAL  APPEARANCES.  755 

globule  of  mucus.  Harvey  states  that  this  was  noted  a  few- 
times  in  his  reports.  Baraban '  discusses  the  condition  of  the 
epithelium  of  the  air  passages  in  hanging. 

The  condition  of  the  lungs  and  heart  varies  according  to 
whether  death  is  due  to  syncope  or  asphyxia.  Ogston  found,  in 
23  cases,  the  lungs  were  expanded  in  4  and  collapsed  in  2. 

Harvey  says  the  lungs  are  congested  in  over  seven-eighths 
of  the  cases ;  emphysematous  in  a  few ;  and  subpleural  ecchy- 
moses  present  in  a  few.  Patenko*  experimented  on  dogs  by 
hanging  them.  When  the  constriction  occurred  after  expira- 
tion the  lungs  were  congested;  when  after  inspiration,  not  con- 
gested. In  the  first  case  (p.  223)  the  blood  flows  from  the 
periphery  to  the  heart  and  thence  to  the  lungs,  but  cannot  flow 
from  the  lungs  because  of  the  difficult  circulation  in  the  dilated 
pulmonary  vessels  and  deficiency  of  intrathoracic  pressure. 
There  is  in  both  cases  cerebral  congestion  in  the  region  of  the 
bulb.  Tardieu  holds  that  punctiform  ecchymoses  and  apo- 
plexies do  not  occur  in  hanging  unless  suffocation  has  preceded. 
Pellier,^  however,  found  these  ecchymoses  14  times  in  22  cases. 
He  says  that  the  lesion  is  not  characteristic  of  suffocation,  and 
quotes  Lacassagne,  Grosclaude,  Dechoudans,  Vicq,  Chassaing, 
and  Legroux  to  the  same  purpose.  Hofmann  *  says  that  the 
ecchymoses  are  relatively  rare  in  adults.  Maschka '  found 
them  18  times  in  153  cases. 

Harvey  states  that  the  presence  of  serum  in  the  pericar- 
dium seems  more  a  matter  of  time  elapsed  after  death  than 
anything  else.  Still  the  fact  is  that  it  is  found  much  oftener  in 
strangulation  than  in  hanging.  The  difference  is  explained 
by  the  comparative  slowness  of  death  in  strangulation.  Harvey 
finds  that  in  about  one-half  of  the  cases,  if  the  bodj-  is  fresh,  the 
right  side  of  the  HEART,  pulmonary  artery,  and  vense  cavse  are 
full  of  dark  fluid  blood,  the  lungs  being  also  much  congested, 
and  the  signs  of  death  by  asphj^xia  well  marked.  When  blood 
is  found  in  both  sides  of  the  heart,  it  is  probable  that  death  is 
due  to  neuro-paralysis.  When  decomposition  is  advanced  all 
the  cavities  are  often  empty.  Taylor  says  that  if  the  examina- 
tion is  delayed  for  several  days,  the  distention  ma}^  not  be 
observed. 

iRev.  Med.  do  I'Est,  1890,  xxii.,  pp.  ^  Oj).  cit.,  p.  105. 

545-554.  •'Lehrbuch.  j).  537. 

-Ann.  d'Hyg.,1885,xiii.,pp.  209-228.  '  Op.  cit.,  p.  GOT. 


750  HANGING — LAMB. 

The  STOMACH  is  often  much  congested,  and  this  fact  might 
sometimes  suggest  the  possibility  of  poisoning.  The  liver, 
SPLEEN,  and  KIDNEYS  are  usually  much  congested.  Eofmann ' 
says  that  this  occurs  in  the  kidney  onlj  when  the  bod^  has  been 
hung  a  long  time. 

The  BRAIN  is  rarely  much  congested.  In  101  cases  Remer 
found  hemorrhage  but  once;  and  in  106  cases  Casper  failed  to 
find  it.  Tardieu  °  says  the  brain  is  oftenest  anaemic.  If,  how- 
ever, the  body  is  cut  down  and  placed  horizontall}",  the  blood- 
vessels of  the  brain  may  fill  up.  Evidence  may  be  found  in  the 
brain  suggesting  insanity  and  therefore  an  explanation  of  a 
probable  suicide.  Harvey  says  that  hemorrhages  in  or  about 
the  brain  are  found  in  a  much  larger  proportion  of  cases  in 
India  than  in  Europe  in  cases  of  hanging.  "No  common  con- 
dition likel}'  to  cause  extravasation  is  apparent,  only  one  man 
being  noted  as  plethoric,  but  in  many  the  rope  seems  to  have 
been  very  tight."  Champouillon '  reports  a  case  of  suicide  in  a 
man,  age  fifty-two;  the  rope  broke  and  the  body  fell.  The 
physician  who  made  the  necroscopy  reported  a  rupture  of  the 
pons  Varolii.  Champouillon  believed  that  the  rupture  must 
have  been  made  in  removing  the  brain  from  the  skull.  Wilkie  * 
reports  a  judicial  hanging  in  which  a  man  age  about  twenty- 
five,  fell  about  three  and  one-half  feet.  A  recent  clot  was  found 
in  the  brain.  The  experiments  of  Brouardel  of  hanging  rab- 
bits showed  the  brain  ansemic. 

The  conjunction  of  the  following  appearances  would  suggest 
that  the  hanging  had  been  of  some  duration :  lividity  of  face, 
congestion  and  prominence  of  eyes,  dryness  of  skin  under  the 
ligature,  deep  furrow,  congestion  of  sexual  organs,  swelling  and 
lividity  of  lower  limbs,  hypostatic  congestion  of  lungs. 

Page  experimented  on  a  young-  cat  and  young  dog;  both  were  hung 
in  the  same  way.  Examination  of  the  cat  showed  the  veins  generally 
engorged;  sublingual  veins  much  engorged;  tongue  protruded  slightly 
and  much  swollen;  no  frothy  mucus  in  bronchi.  In  the  dog  the 
tongue  did  not  protrude  and  was  not  swollen;  right  cavities  of  heart 
contained  blood,  left  empty;  brain  and  other  organs  normal.  In  the 
cat,  the  lungs  were  uniformly  congested,  dark  red;  no  ecchymoses. 
In  the  dog,  the  lungs  were  much  distended,  posterior  borders  mottled 

'Op.  cif.,  p.  597.  3B„n    Soc.  Med.  Leg.,  Paris,  1875- 

Wp.  cit.,  pp.  44,  54.  76,  iv.,  p.  373. 

•*  Indian  Med.  Gaz.,  1881,  xvi.,  p.  275. 


PROOF   OF   DEATH   BY   HANGING.  757 

violet;  emphysematous  patches  on  surface;  no  apoplectic  effusions; 
subpleui'al  ecchymoses  bright  red,  irregular,  cleai-ly  defined  in  outer 
surface,  most  numerous  toward  the  roots  and  on  the  lower  lobes. 

Pellereau '  gives  an  account  of  hanging  as  seen  by  him  in  warm 
climates.  He  had  not  seen  the  elongation  of  the  neck  described  nor 
the  erection  of  the  penis,  nor  subconjunctival  ecchymoses,  nor  fracture 
of  larjnix,  nor  rupture  of  walls  of  carotid  artery,  nor  subpleural  ecchy- 
moses, nor  fracture  of  vertebra.  He  alwaj's  found  a  mark  on  the 
neck;  the  left  cavities  of  the  heart  always  empty,  the  right  always  full 
of  black  blood.  Mackenzie  says  that  in  130  cases  of  suicidal  hang- 
ing, the  protrusion  of  the  tongue  between  the  teeth,  the  open  and 
protruding  eyes,  clinched  hands,  and  blue  nails  were  very  fi-equent, 
the  tongue  was  found  bitten  many  times,  there  were  urethral  and 
rectal  discharges  and  rupture  of  carotid  artery.  The  penis  was 
found  erect  several  times.  The  hyoid  bone  fractured  24  times  in  93 
cases.  In  no  case  was  the  larynx  or  vertebra  fractured.  In  73 
cases  ropes  were  used;  in  30,  portions  of  clothing.  The  marks  of 
ropes  were  always  well  defined,  indented,  and  parchment-like;  the 
marks  of  soft  ligatures  faint  and  reddish'.  In  no  case  were  the  mus- 
cles of  the  neck,  the  larjTix,  trachea,  or  large  bronchi  injui'ed,  and 
in  none  was  there  subcutaneous  hemorrhage  or  blister. 


Proof  of  Death  by  Hanging. 

As  in  strangulation,  no  single  sign  in  any  given  case  is  suf- 
ficient of  itself  to  prove  that  death  was  caused  by  hanging. 
But  the  sum  total  of  the  lesions  found,  viewed  in  the  light  of 
the  surroundings  of  the  bod}',  will  suffice  to  lead  to  a  definite 
conclusion. 

The  fact  that  a  bod}'  has  been  found  suspended  does  not  of 
itself  prove  that  hanging  caused  the  death,  because  the  victim 
may  have  been  killed  in  some  other  way,  and  the  body  after- 
ward hung  up  to  avert  suspicion.  Chevers  records  many  cases 
of  this  kind. 

The  value  of  the  presence  or  absence  of  marks  on  the  neck 
and  the  characters  of  the  marks  has  been  questioned.  Orfila, 
Casper,  and  Vrolik  have  shown  by  experiment  that  if  a  body  is 
hanged  within  one  or  two  hours  after  death  the  furrow,  parch- 
ment skin,  lividity,  and  the  density  of  the  connective  tissue 
will  appear  just  as  is  seen  when  suspension  has  occurred  dur- 
ing life;  but  ecchymoses  and  infiltration,  clotted  blood  in  the 

'Ann.  d'Hyg.,  188G,  xvi.,pp.  108-125. 


758  HANGING — LAMB. 

skin,  connective  tissue,  and  muscles  of  the  neck  suggest  suspen- 
sion during  life. 

If  a  cord  is  removed  immediately  after  death,  there  may  be 
scarcely  any  mark  at  all. 

Tardieu  collected  261  cases  of  suicide  by  hanging  where  the 
subject  was  not  entirely  off  the  ground.  In  168  the  feet  rested 
on  the  ground;  in  42  the  subject  was  kneeling;  in  29  lying- 
down  ;  in  19  sitting,  and  3  were  huddled  up  or  squatting.  Fatal 
hanging  may,  therefore,  occur  in  almost  any  position  of  body. 
He  shows  incomplete  hangings  by  thirteen  plates.  Tajdor  also 
collected  reports  of  11  cases  in  a  few  years;  in  3  the  subjects 
were  nearly  recumbent;  in  -4,  in  a  kneeling  position;  in  4, 
sitting.  Remer  in  101  cases  of  suicidal  hanging  found  in  14 
that  the  body  was  either  standing  or  kneeling;  in  1,  sitting. 
Duchesne  published  58  cases  of  partial  suspension,  26  of  which 
were  new.  Some  of  these  failures  of  complete  suspension  were 
due  to  soft  and  elastic  cords.' 

Taylor  says  that  "  that  which  is  difficult  to  a  conscientious 
medical  jurist  in  confining  himself  to  the  medical  facts  is  often 
easily  decided  by  a  jury  from  these  as  well  as  the  general  evi- 
dence afforded  to  them." 

The  limbs  may  be  secured  by  the  suicide  before  hanging 
himself.  Persons  even  with  some  disability  of  the  hand  have 
suicided  hj  hanging.  Blindness  is  no  obstacle,  nor  age ;  a  boy 
as  young  as  nine  and  a  man  as  old  as  ninety-seven. 

Burger  ^  f ullj^  discusses  the  question  whether  the  hanging  is 
before  or  after  death. 

Hanging — Suicidal,  Homicidal,  or  Accidental? 

Hanging  is  usually  suicidal.  Lesser '  states  that  for  three 
years,  1876-79",  there  were  admitted  to  the  Berlin  morgue  274 
bodies  of  "  hanged,"  of  which  272  were  suicidal ;  2  infants  of  three 
and  eighteen  months,  homicidal.  One  man  had  first  tried  to  kill 
himself  with  sulphate  of  copper ;  another  by  cutting  his  throat ; 
a  woman  by  cutting  her  arm.  The  other  cases  were  uncompli- 
cated.    PeUier  states  that  the  number  of  suicides  in  France 

>"Med.  Jur.,"  Am.  ed.,  1892,  p.  ^Yiev.    f.    ger.    Med.,  etc.,    1880, 

408.  xxxii.,  p.  232,  foot-note. 

*  Freidreich's    Bl.    f.    ger.  Med., 
1890,  xxi.,  pp.  149-171. 


HANGING — SUICIDAL,  HOMICIDAL,  OR   ACCIDENTAL?       759 

from  1876-1880  was  13,445,  and  nearly  all  were  by  hanging. 
Taj'lor '  states  that  2,570  persons  committed  suicide  by  hanging 
ill  England  in  five  years,  1863-67;  four-fifths  of  these  were 
males.  Harvey^  reports  for  three  years  1,412  cases  of  hanging 
in  India,  of  which  2  were  accidental,  in  3  there  was  presump- 
tion of  homicide,  the  rest  probably  all  suicidal. 

Feebleness  of  body  does  not  preclude  subjects  taking  their 
lives  in  this  way.  Thej'  sometimes  also  wound  or  poison  them- 
selves first  and  hang  themselves  afterward.  A  subject  being 
found  suspended  in  a  room  fastened  on  the  inside,  would  be 
suggestive  of  suicide.  The  absence  of  signs  of  struggling  or 
of  any  marks  of  injury  also  favors  the  idea  of  suicide. 

The  possibility  of  a  suicide  breaking  a  rope,  being  injured 
by  the  fall,  and  rehanging  himself  successful!}',  must  be  ad- 
mitted (Cases  57,  58) .  The  possibility  of  blood  flowing  after 
death  must  not  be  forgotten. 

It  is  worthj^  of  note  that  after  beating  or  other  violence 
children  and  women  may  commit  suicide  from  shame.  Again, 
as  Tardieu  says,  many  have  hung  themselves  while  partiallj" 
intoxicated,  and  it  is  likeh'  that  some  such  have  just  previous 
to  the  suicide  met  with  falls  or  other  accidents  which  have  left 
marks  like  those  of  violence.  He  also  records  the  case  of  a 
woman  who  fastened  a  cord  to  a  bed-post,  put  her  head  in  a 
noose  while  kneeling  on  the  bed,  and  made  a  deep  wound  in 
her  arm  with  a  razor.  She  closed  the  razor,  laid  it  aside,  and 
fainted  from  loss  of  blood.  She  must  then  have  fallen  forward 
and  died  from  the  pressure  of  the  cord  on  her  neck.^ 

Homicidal  hanging  is  rare  but  does  occur.  Where  the 
hands  are  tied  together;  where  the  injuries  produced  by  the 
cord  are  severe;  where  there  are  contusions  and  well-marked 
ecchymoses ;  where  the  larjmgeal  cartilages  and  hj'oid  bone  are 
fractured  or  the  cervical  vertebrae  dislocated  or  fractured ;  or 
where  the  carotids  are  injured  or  there  is  hemorrhage  into  their 
walls;  where  there  are  severe  wounds,  the  hemorrhage  from 
which  would  be  sufficient  to  threaten  syncope ;  where  there  are 
man j^  marks  of  violence  on  the  body ;  where  there  is  evidence 
of  a  severe  struggle — in  all  these  cases  murder  may  be  reasona- 
bly suspected.     The  number,  situation,  extent,  and  direction  of 

1  "Med.  Jur.,"  Am.  ed.,   1880,  p.  '^Indian  Med.  Gaz..  1876,  xi.,  p.  3. 

448.  ^^Oj).  cit.,  p.  132. 


760  HANGING — LxVMB. 

injuries  must  be  carefully  noted  and  weighed.  If  these  are  out 
of  proportion  to  the  ligature,  the  suspension,  etc.,  they  strongly 
suggest  homicide,  although  they  may  occur  in  sviicide  (see 
Cases  4,  11,  18,  20,  28,  29,  44,  52,  55,  59,  66). 

Homicidal  hanging  may  be  committed  by  an  assailant  who 
is  strong  on  a  subject  who  is  weak,  on  a  child,  a  woman,  an 
old  person ;  on  one  stupefied  by  liquor  or  narcotic  poison ;  or  by 
many  combined  against  one  person. 

Cases  are  reported  where  injuries  were  inflicted  or  poison 
given,  and  the  subject  was  afterward  hanged  to  avert  suspicion. 
Most  of  these  cases  are  those  of  murder  either  by  strangulation 
or  suffocation  (Cases  64,  65,  67,  68,  69,  70,  74). 

Sometimes  hanging  is  accidental.  Children  and  even  older 
persons  play  at  hanging  successfully.  Taylor  mentions  the  case 
of  a  boy  who  witnessed  a  hanging  and  afterward  tried  the  ex- 
periment himself  to  ascertain  the  sensation,  and  caused  his 
own  death. 

Tardieu  1  relates  the  case  of  a  man,  T.,  age  37,  of  small  stature, 
feeble  constitution,  very  thin,  of  sinister  face,  eyes  hollow  but  lively, 
cunuing  nose  and  mouth,  who  meeting  a  man  aged  81,  learned  that  he 
had  some  trouble  with  his  leg  and  promised  to  cure  him.  The  old  man 
lived  alone.  T.  told  him  to  buy  a  strong  cord  as  thick  as  his  little 
finger  and  one  and  one-half  yards  long,  and  keep  the  whole  thing  a 
secret.  T.  would  see  him  at  his  room  at  7  P.M.  The  old  man  became 
susjDicious  and  had  T.  arrested.  The  investigation  showed  that  already 
T.  had  made  away  with  three  old  men  by  hanging,  who  were  kno\\Ti 
to  be  opposed  to  suicide.  Their  bodies  showed  no  trace  of  violence. 
Two  others  had  escaped  when  the  cord  was  passed  around  their  necks. 

Tardieu  gives  a  number  of  cases  of  suicidal  hanging  which 
were  falsely  attributed  to  criminal  violence,  in  which  the  press- 
ure of  public  opinion  joined  to  circumstances  improperh'  ex- 
plained by  inexpert  physicians  caused  deplorable  judicial  errors. 

illustrative  cases. 

Suicide. 

1.  Harvey:  Indian  Med.  Gaz.,  1876,  xi.,  p.  2. — Man,  age  30.  Found 
hanging  by  turban  to  bars  of  cell  door;  slip-knot  around  neck;  heai't 
beating  feebly;  died  in  about  a  minute  after  being  cut  down.  ''The 
point  of  suspension  was  forty-seven  inches  from  the  ground,  the  posi- 

'  Oji.  cit. ,  p.  66. 


ILLUSTRATIVE   CASES — SUICIDE.  761 

tion  of  the  iioose  twenty-eight  inches,  and  the  feet  were  fortj'-two 
inches  away  from  the  door  snpijorted  on  the  toes."  Experiment  showed 
that  the  turban  coukl  not  have  borne  the  full  weight  of  the  bod^-.  He 
died  from  strangulation. 

2.  Ibid.,  p.  3. — Insane  man,  age  60.  Put  his  neck  in  a  V-shaped 
fork  of  a  tree  and  let  his  body  swing.  A  broad  abrasion  found  on  each 
side  of  neck.  Scalp,  brain,  and  membranes  much  congested;  reddish 
serum  in  lateral  ventricles;  two  ounces  clear  fluid  in  pericardium. 
Lungs  congested;  all  the  heart  cavities  contained  blood. 

3.  Ibid.,  p.  5. — Woman,  age  28.  Two  marks  of  ligature  on  neck; 
one  deep  and  circular  passed  up  behind  left  ear;  the  other  passed  from 
the  circular  mark  behind,  crossed  it  on  either  side  under  lower  jaw, 
thence  up  to  chin.  Appeared  at  first  to  be  a  case  of  strangulation  fol- 
lowing hanging;  but  the  two  marks  were  finally  explained,  that  after 
the  body  was  taken  down  it  was  ordered  up  again  until  the  police 
should  arrive. 

4.  Ibid.,  p.  5. — Man,  age  45;  first  cut  his  tln-oat  and  then  hung  him- 
self. "He  had  probably  only  just  had  time  to  hang  himself  before 
dying." 

5.  Ibid.,  2^- ^0. — Woman;  hung  herself  with  a  twisted  cloth.  There 
was  much  ecchymosis  about  the  neck  and  upper  part  of  chest;  lungs 
much  congested;  fibrin  clot  in  left  mitral  orifice;  liver,  spleen,  and 
stomach  congested;  transverse  ligament  of  atlas  ruptured. 

6.  Ibid. — Man,  age  39.  Distinct  mark  of  cord  around  neck;  no 
other  mark  of  violence;  laceration  of  larynx  and  dislocation  of  odon- 
toid process;  hands  clinched;  involuntary  discharge  of  semen;  thoracic 
and  abdominal  organs  normal. 

7.  Ibid. — Man,  age  70.  Mark  of  cord  around  the  neck,  superficial 
in  front,  deep  behind;  second  cervical  vertebra  dislocated;  tongue 
slightly  protruding;  fingers  clinched;  meningeal  vessels  engorged; 
lungs  tubercular,  congested;  right  heart  contained  a  little  coagulated 
blood. 

8.  Ibid. — Sex  and  age  not  given.  Found  hanging  on  a  tree;  usual 
signs;  odontoid  process  fractured;  rope  in  a  double  noose  without 
knot,  a  common  dooree,  such  as  is  used  for  drawing  water. 

9.  Ibid.,  p.  32. — Man,  age  50.  Face  livid,  eyes  red  and  protruding; 
teeth  clinched  ;  lower  jaw  retracted;  tongue  behind  the  teeth;  hands 
and  feet  contracted;  anus  covered  with  fcccal  matter;  circular  de- 
pressed mark  of  cord  around  neck,  hard  as  parchment,  slightly  ecchy- 
mosed  along  edges;  some  infiltration  of  blood  in  connective  tissue  be- 
neath the  cord;  some  tearing  of  soft  parts;  laryngeal  cartilage  tlis- 
placed.  Brain  and  membranes  congested.  Right  cavities  of  heart 
distended  with  dark  blood.     Trachea  congested. 

10.  Hurpy:  Ann.  d'Hygiene,  1881,  tv".,  p/>.  359-367,  in'fli  illustra- 
tion.— Woman,  age  77,  suicided  by  hanging  in  the  following  \\a\  •.  a 


762 


HANGING— LAMB. 


short  cord  was  fastened  by  one  end  to  a  table  leg;  the  other  end  was 
around  her  neck;  she  lay  on  the  floor,  face  downward,  clothing  not 
disordered.  The  brain  was  congested;  lungs  congested  and  emphysema- 
tous; left  side  of  heart  empty  (see  Fig.  23). 

11.  Champoiiillon:  Same  journal,  1876,  xlvi.,  p.  129. — Man,  age 
62  ;  first  tried  to  suffocate  himself  with  charcoal  smoke  and  then  hung 
himself,  but  the  rope  broke  and  the  body  fell.     He  lived  two  days. 

12.  Pellier :  Lyon  thesis,  1883,  No.  188,  p.  72. — Boy,  age  16,  hung 
himself;  rope  broke;  he  was  resuscitated;  reddish  circular  furrow  on 


Fig.   23.— Suicide.     The  cord  on  the  neck  is  44  cent,  from  the  cord  on  the  table  leg;  vertex 
of  head  30  cent,  from  table  leg.    Case  reported  by  Hurpy  (see  p.  717,  Case  10). 


neck,  not  like  parchment;  he  had  erection  and  ejaculation ;  buzzing  in 
his  ears  and  flashes  before  his  eyes. 

13.  Lacassagne:  Pellier  thesis  {supra),  p.  71. — Man;  hung  him- 
self; was  cut  down  and  sent  to  hospital;  was  aphonic  for  four  days: 
then  a  severe  bronchitis  set  in,  and  at  the  end  of  a  week  a  gangrenous 
expectoration.     The  mark  of  the  cord  lasted  fifteen  days. 

14.  Maschka:  Archiv.  deVanthrop.  crim.,  Paris,  1886,  i.,  pp.  351- 
356. — Man,  age  about  60,  found  dead  under  a  tree  in  the  woods  near 
Prague.  No  sign  of  violence.  A  cord  thick  as  a  sugar-loaf  around 
the  neck;  another  cord  attached  to  a  branch  of  the  tree.  There  was  at 
first  a  strong  suspicion  of  violence,  but  the  conclusion  reached  was  that 
he  had  hung  himself  and  that  the  body  had  fallen  frona  breaking  of 
the  coi'd;  that  death  was  due  to  asphyxia  was  showTi  by  the  furrow  on 
the  neck,  the  dark  liquid  blood,  and  the  congested  lungs.  There  was 
no  infiltration  below  the  furrow  in  the  neck,  and  no  lesion  of  larynx. 
The  man  had  shown  signs  of  melancholy. 

15.  Friedberg:  Virchow's  Archiv,  1878,  Ixxiv.,  p.  401. — Suicidal 
hanging.  Examination  twenty-eight  weeks  after  death.  The  front  of 
the  neck  showed  a  groove  above  the  larynx,  firm  and  of  gray  color; 
ecchymosis  in  subcutaneous  tissue. 


ILLUSTRATIVE   CASES— SUICIDE.  763 

16.  Bollinger:  Friedreich's  Bldtt.  f.  ger.  Med.,  1889,  xl.,  p.7.— 
Man,  age  48;  found  dead.  Had  made  a  ligature  out  of  a  night-gown 
and  tied  it  around  his  neck,  the  other  end  around  top  of  a  low  bed- 
post; his  neck  hung  by  the  ligature  placed  below  the  larjTix.  Illus- 
trated. 

17.  Med.  Times  and  Gaz.,  London,  1860,  ii.,  p.  39. — Woman;  had 
collected  accounts  of  celebrated  persons  Avho  had  been  hanged;  finally 
hanged  herself. 

18.  E.  Hoffman:  Mitt.  d.  Wien.  Med.  Doct.  Colleg.,  1878,  iv.,  JW- 
97-112. — 1st.  Woman,  age  about  25;  found  dead  sitting  in  bed,  a  hand- 
kerchief around  her  neck  fastened  to  the  bed-curtain.  The  police 
thought  she  had  been  killed  and  then  hung,  but  the  physician  con- 
cluded that  she  had  committed  suicide.  An  examination  of  the  stom- 
ach showed  that  she  had  previously  tried  to  poison  herself  with  ar- 
senic. 

19.  2d.  Woman,  age  51;  found  hanging  in  half-lying  position. 

20.  3d.  Man,  age  50.  First  tried  to  kill  himself  with  phosphorus, 
then  sulphuric  acid;  finally  hung  himself  in  a  half -kneeling  position. 

21.  MUller-Beninga :  Berlin,  klin.  Woch.,  1877,  xiv.,  p.  481. — 
Man,  age  40;  hung  himself.  There  was  no  swelling  of  genitals  and 
no  soiling  of  clothing.  Necroscopy  showed  death  from  asphyxia,  and 
in  urethra  near  meatus  quite  a  quantity  of  seminal  fluid,  as  shown  by 
microscopical  examination. 

22.  Tardieu:  Op.  cit.,  p.  18. — The  Prince  of  Conde  was  found 
hanging  in  his  room,  August  27th,  1830.  He  was  suspended  by  two 
handkerchiefs  to  a  window  fastening,  his  feet,  however,  touching  the 
floor.  The  knot  was  at  the  back  of  the  neck  (as  shown  by  the  illustra- 
tion), the  face  turned  slightly  to  the  left,  the  tongue  protruding;  face 
discolored;  mucus  at  the  mouth  and  nose;  arms  hanging  and  stiff; 
fists  shut;  heels  raised;  knees  half  bent.  The  text  says  that  the  knot 
was  nearly  under  the  right  ear,  but  the  illustration  shows  a  different 
position  (see  Fig.  32,  p.  743). 

23.  Allison:  Lancet,  1869,  i.,  p.  636. — Three  cases  of  sviicide  by 
hanging,  in  which  there  was  no  mark:  1st.  Woman,  hung  herself 
with  a  piece  of  sheep-net  band;  cut  down  before  death.  2d.  Man, 
hung'  with  plough-string;  cut  down  in  about  six  minixtes.  3d.  A  heavy 
man. 

24.  Tardieu:  Op.  cit.,  pp.  93-105. — Woman,  died  of  coma  and  as- 
phyxia from  suicidal  hanging,  according  to  report  of  Drs.  Costan  and 
i'acieu.  Tardieu  approved  their  rej^ort.  It  was  at  first  thought  a  case 
of  homicide  with  subsequent  hanging,  more  especially  because  of  the 
kind  of  knot  used,  noeud  d'artificier.  But  Tardieu  showed  that  it  Avas 
also  a  noeiid  de  batalier.  Her  feet  touched  a  chair,  and  hei-  knees 
were  bent.  There  was  a  neckcloth  in  front  of  her  mouth,  but  it  did 
not  seem  to  have  interfered  with  respiration. 


764  HANGING — LAMB. 

25.  Ibid.,  pp.  67-72. — The  famous  case  of  Marc-Antoine  Galas,  who 
committed  suicide  by  hanging  (see  Voltaire,  "Traite  sur  le  tole- 
rance," etc.,  in  Nouv.  Philos.  Histor.,  1772,  xxxii.,  p.  30).  He  hung 
himself  to  a  door.  No  sign  of  violence.  The  city  hangman  said  it  was 
impossible  for  a  man  to  commit  suicide  in  that  way.  The  father  was 
accused  and  convicted  of  homicide.  Tardieu  shows  that  the  act  was  a 
suicide. 

26.  Ibid.,  p.  72. — Another  famous  case.  A  woman,  age  30,  hung 
herself  to  the  key  of  her  bedroom  door.  Her  husband  cut  her  down. 
He  was  accused  and  convicted  of  the  crime  and  condemned  to  prison, 
where  he  died.     Tardieu  showed  that  the  case  was  one  of  suicide. 

27.  Hofmann:  Wien.  med.  Presse,  1880,  xxi.,  p.  201. — Man,  age 
68,  suicide  by  hanging.  There  was  profuse  hemorrhage  from  both 
ears. 

28.  Ibid.:  1878,  xix.,  pp.  489^93. — Woman,  found  dead  sitting  in 
bed.  She  first  tried  to  poison  herself  with  arsenic,  then  hung  her- 
self. 

29.  Ibid. — Man,  tried  to  poison  himself  with  phosphorus  and  sul- 
phuric acid,  then  hung  himself.  There  was  a  transverse  rupture  of  the 
sterno-cleido  mastoid  muscle  and  suffusion  in  its  sheath. 

30.  Maschka:  Wien.  med.  Woch.,  1880,  xxx.,  pp.  714,747,  1075. — 
Man,  age  63.  It  was  at  first  a  question  of  suicide  by  hanging  or 
homicide  by  strangling.     He  concluded  that  it  was  the  former. 

31.  Ibid. — Also  man,  age  58.     Similar  case.     Same  opinion. 

32.  Ibid.:  1883,  ^u\rm.,pjp.  1118-1120.— Woman,  age 23.  Question 
whether  she  committed  suicide  by  hanging  or  was  strangled  and  then 
hung.     Opinion,  that  it  was  a  case  of  suicide. 

33.  Hofmann:  Allg.  Wien.  med.  Zeit.,  1870,  .xt\,  pp.  192-214. — 
Man,  age  60.  Suicide  by  hanging  or  homicide ;  opinion,  that  it  was 
the  former. 

34.  Van  Haumeder :  Wien.  med.  Woch.,  1882,  xxxii.,  pp.  531-533. 
— Suicide  by  hanging  or  homicide.  There  were  many  wounds  in  the 
head;  these  occurred  during  the  delirium  of  typhus. 

35.  Maschka:  ''Sammlung  gericht.  Gutacht.,''^  etc.  (Prag),  Leipzig, 
1873,  p.  137. — Boy,  age  9;  found  dead  in  sitting  position.  Injuries  on 
neck  and  elsewhere.  Question,  had  he  hung  himself  or  been  choked  ? 
Were  the  injuries  inflicted  before  or  after  death  ?     Opinion,  suicide. 

36.  Ibid.,  2^-  144. — Boy,  age  13.  Found  hanging  in  sitting  position. 
Question  whether  murder,  suicide,  or  accident.     Opinion,  suicide. 

37.  Ibid.,  p.  149. — Woman,  age  60;  found  hanging,  sitting  posi- 
tion.    Suicide  or  homicide.     Opinion,  suicide. 

38.  Ibid.,  p.  156. — Woman,  age  30;  found  hanging.  Opinion,  sui- 
cide. 

39.  Ibid.,  p.  165. — Man,  age  63.  Suicide  by  hanging,  or  homicide 
by  strangling  ?    Opinion,  suicide. 


ILLUSTRATIVE   CASES — SUICIDE.  765 

40.  Berliner:  Viert.  f.  ger.  Med.  und  off.  San.,  1874,  xx.,pp.  245- 
253. — Woman,  age  30  ;  found  hanging.     Ojiinion,  suicide. 

41.  Deininger:  Friedreich's  Blat.  ^er.  Med.,  1884,  jcxjcv.,  pj^-  '^^~ 
59. — Woman,  age  61 ;  fouad  hanging.     Opinion  given,  suicide. 

42.  Mader:  Bericht  d.  k.  k.  Rud.  Stiff.,  Wien.  (1875),  1876,  p, 
378. — Woman,  age  43  ;  tried  to  hang  herself.  She  was  at  once  cul 
down,  bled,  and  taken  to  hospital  unconscious.  Next  day,  face  red; 
pulse  and  temperature  normal.  Third  day,  conscious  and  could  s])eak, 
but  not  aloud  ;  tongue  twisted  and  turned  to  right ;  paralysis  of  right 
hypoglossal  nerve.  Uvula  drawn  to  left.  Skin  of  right  limb  felt 
"furry."  Applied  electricity  and  gave  strychnine;  phonation  was 
more  distinct  during  the  use  of  the  battery.  Two  months  later  she  was 
still  aphonic,  but  the  vocal  cords  were  in  better  action.  The  right 
hemiparesis  was  lessened. 

43.  Grant:  Lancet,  1889,  ii.,  p.  265. — Man,  age  48;  found  sitting 
against  a  door,  hung  to  the  knob  "by  a  handkerchief. 

44.  White:  Lancet,  1884,  ii.,  p.  401. — Woman,  age  53,  insane. 
Made  several  attempts  at  suicide ;  once  with  a  stoclcing  around  her 
neck,  once  with  an  apron;  the  last  time  by  fastening  a  pox'tion  of  her 
dress  to  a  ladder.  She  was  quickly  cut  down,  cold  affusion  a])plicd, 
and  artificial  respiration  (Sylvester).  The  eyes  were  prominent  and 
glassy,  pupils  widely  dilated,  no  reaction  to  light;  conjunctiva?  insen- 
sitive ;  lips  livid  ;  tongue  swollen  and  pale ;  face  pale ;  oblique  de- 
pressed mark  on  neck,  most  marked  on  left  side  ;  skin  cold  ;  no  pulse ; 
no  heart-beat  recognizable  ;  no  respiration  ;  no  reflex  action.  Galvan- 
ism failed  to  arouse  any  muscular  action.  The  details  are  too  numer- 
ous to  give  all  of  them.  There  w^as  redu])lication  of  heart-sounds  for 
several  days,  due  to  interference  with  pulmonary  cii'culation.  She  re- 
covered both  bodily  and  mental  health. 

45.  Richards:  Indian  Med.  Gaz.,  1886,  xxi.,  p.  78. — Man,  age  20; 
suicide  ;  was  cut  down  and  lived  for  four  days. 

46.  Kite:  Univ.  Med.  Mag.,  1888-89,  i.,p.  475.— Man,  age  69;  sui- 
cide. 

47.  Terrier:  Prog.  Med.,  1887,  vi.,  pp.  211-214.— Two  men,  age  29 
and  25,  insane.     Attempted  suicide  by  hanging.     Both  resuscitated. 

48.  Nobeling:  Aertz.  Intellig.-hl.,  1884,  xxxi.,}^.  213. — Two  suicides 
by  hanging  ;  men,  ages  24  and  40. 

49.  Ritter:  Allg.  Wien.  med.  Zeit.,  1886,  xxxi.,  p.  375.— Soldier, 
found  hanging.  Cut  down  in  ten  minutes.  Artificial  respiration  ap- 
plied; fifteen  minutes  later,  an  effort  at  resinration;  face  changing  from 
blue  to  white  and  then  to  red;  pulse  small,  irregular;  still  imconscious ; 
mark  of  ligature  distinct ;  a  few  hours  later  had  a  maniacal  seizure  ; 
gave  morphia  hypodermically  and  he  slept ;  was  also  aphonic.  Gradu- 
ally recovered  and  returned  to  duty. 

50.  Strassmann:  Viert.  f.  ger.  Med.,  1888,  xlviii.,  pp.  379-381.— 


"66 


HANGING LAMB. 


Three  cases  of  suicidal  hanging   in  men,  ages  27,  37,  and  40.     The 
last  was  found  kneeling. 

51.  Balta :  Pest.  Med.  Chir.  Presse,  1892,  xxviii.,  p.  1244. — Man, 
age  45-50;  hanging;  suicide.    Thyroid  cartilage  and  hyoid  bone  broken. 

52.  Hackel:  Op.  cit.,  p.  35. — Man,  found  hanging  to  a  beam  by  a 
sheet.     Had  previously  tried  to  choke  himself  with  his  hands. 

53.  Ibid. — Two  cases  of  suicidal  hanging  where  the  cord  made  no 
mark.     In  the  first  the  body  hung  free  ;  in  the  second  the  body  was 

partly  supported.  In  the  first 
there  was  no  rubbing  of  the 
skin;  in  the  second  the  body  was 
soon  cut  down. 

54.  Freund:  Wien.  Min. 
TFoc/i.,  1893,  r?.,  pp.  118-121. 
— Man,  found  hanging ;  cut 
'down,  but  could  not  be  resusci- 
tated. Ligature  between  hj'oid 
bone  and  larynx,  then  crossed 
over  itself  about  middle  line  of 
neck,  passed  up  along  each  side 
of  face,  knotted  above  the  head, 
then  thrown  over  a  beam,  and 
on  the  other  side  the  loop  .was 
caught  between  his  legs. 

55.  Hoffman:  Op.  cit., p.  525, 
illustrated.  —  Case  communi- 
cated by  Dr.  Rosen,  of  Odessa. 
Man,  age  21,  and  woman,  age 
17,  hung  themselves  by  same 
ligature  thrown  over  an  open 
door,  one  of  them  on  each  side. 

They  had  previously  tried  other  means  of  suicide   without  success 
(see  Fig.  24). 

56.  Ibid.,  p.  530. — Man  found  hanging  by  handkerchief  to  branch  of 
tree  but  sitting  on  the  ground.  Mark  of  handkerchief  superficial  and 
pale.  When  the  necroscopy  was  made  the  mark  had  disappeared. 
Also  a  similar  suicide  where  there  was  no  mark  at  all. 

57.  Ibid., 2^.  541. — Man  found  hanging  to  a  window.  Another  man 
cut  the  cord  and  the  suspended  one  fell  into  a  cellar,  fracturing  his 
skuU. 

58.  Ibid. — Man  found  hanging  ;  cut  down  ;  the  fall  caused  rupture 
of  liver. 

59.  Ibid.,  p.  539. — Drunkard  hung  himself;  there  was  evidence  that 
he  had  previously  injured  himself  during  his  ch'unkenness. 

60.  Ibid. — Boy  hung  himself  because  he  had  been  punished  by  the 


Double  Suicide  (see  Case  55). 


ILLUSTRATIVE   CASES — HOMICIDE.  7(57 

schoolmaster.     There  were  marks  on  his  back  and  lower  limbs  from  the 
punishment. 

See  also  Taylor,  "Medical  Jurisprudence,"  pp.  451-452;  Tidy, 
"Medical  Jurisprudence,"  incomplete  hanging.  Cases  33  to  36  and  Q2\ 
Hofmann,  "Lehrbuch,"  p.  538. 

Homicide. 

61.  Harvey:  Indian  Med.  Gaz.,  1876,  an.,  p.  3.— Woman,  age  20, 
feeble.  Her  mother-in-law  had  kicked  her;  she  probably  had  fainted; 
supposing  her  to  be  dead,  the  husband  hanged  her  to  a  tree  within  half 
an  hour  after  the  supposed  death.  Autopsy:  No  marks  of  injury; 
oblique  mark  of  cord  on  right  side  of  neck;  tip  of  tongue  between  the 
teeth;  face  somewhat  livid;  right  side  of  heart  full  of  dark  blood:  lungs 
congested  posteriorly. 

62.  Ibid.,  p.  4. — Woman,  age  38.  Kope  close  under  the  chin  passed 
upward  behind  the  ears.  Head  bent  on  chest.  Large  wound  above 
clavicle.  Under  the  rope  was  a  depression  (made  after  death)  but  no 
hemorrhage.  Much  blood  in  abdomen  and  a  hole  in  the  liver.  Kidney 
bruised  and  blackened.  Right  lung  torn  through;  Ijlood  in  pleurte. 
Wounds  were  supposed  to  be  gunshot,  but  the  husband  confessed  that 
he  had  thrust  a  sharp  solid  bamboo  into  her  body  and  afterward  hung 
it  up.     She  died  of  hemorrhage. 

S3.  Relim:  Friedreich's  Blcit.  f.  ger.  il/ed.,  1883,  xxxiv.,  p>p-  332- 
362. — Man,  age  73;  first  roughly  maltreated;  afterward  hung. 

64.  Tardieu :  Op.  cit.,  p.  125. — WoSkn  found  hanging  in  her  room. 
Circumstances  indicated  homicidal  strangulation  and  tliat  the  hanging 
was  done  to  avert  suspicion.  Post-mortem  examination  showed  the 
base  of  the  tongue  ecchymosed,  and  ecchymosis  extending  up  to  the 
soft  palate ;  mucous  membrane  of  pharynx  congested  ;  connective 
tissue  and  mucous  membrane  between  hyoid  bone  and  larynx  con- 
gested posteriorly;  epiglottis  showed  slight  ecchymosis,  mucous  mem- 
brane red.  These  ecchymoses  were  not  caused  b}'  the  cord,  for  the 
latter  was  placed  below  the  hyoid  bone  and  this  bone  was  not  bi-okcn. 
There  were  also  marks  on  the  collar-bone  like  the  mai'k  of  two  hands. 

65.  Ibid.,  p.  124. — Girl,  15  years  old.  Body  found  hanging.  Post 
mortem  showed  beyond  doubt  that  she  had  been  violated,  then 
strangled,  then  hung.  Her  head  showed  many  ecchymoses  from  either 
the  fist  or  the  foot;  blood  flowing  from  left  ear.  Brain  slightly  con- 
gested. Tongue  between  teeth,  bitten  and  bloody.  On  fi-ont  of  neck 
were  two  marks:  the  lower  were  impressions  of  fingers  close  together, 
nearly  uninterrupted,  and  which  had  bruised,  flattened,  and  tanned 
the  skin,  which  here  was  dry,  hard,  and  horny.  This  lesion  was  above 
the  intraclavicular  notch  and  extended  toward  the  sides  of  tlie  nock 
Avith  regularity  of  curve  and  neatness  of  imprint,  evidently  made  with 


768  HANGING — LAMB. 

the  right  hand.  Above  the  first  furrow  under  the  skin  was  a  kind  of 
track,  less  extended,  more  regular,  a  bruising  of  the  same  nature  as 
the  preceding,  but  continued,  due  to  the  pressure  of  the  index  finger 
and  thumb  of  left  hand.  A  little  below  the  jaw  was  a  livid  place  on 
the  skin,  which  was  otherwise  unaffected  by  the  ligature.  There  was 
nothing  to  indicate  a  circular  action  of  the  ligature.  Froth  in  larynx 
and  bronchi.  Lungs  apparently  normal.  Food  had  passed  from 
stomach  into  oesophagus  and  air-passages. 

66.  Ibid.,  p.  122. — Woman  found  hanging  in  her  room,  and  was 
resuscitated.  She  stated  that  the  man  who  lived  with  her  had  tried  to 
strangle  her  and  then  hung  her.  Tardieu  saw  her  in  hospital.  Res- 
piration shoi't  and  embarrassed;  pains  in  neck  and  jaw.  Found  nar- 
row, circular,  sinuous,  horizontal,  uninterrupted  line  around  the  neck 
below  thyroid  cartilage;  line  everywhere  equal,  deep,  and  three  to  four 
mm.  wide;  the  skin  excoriated  and  covered  with  thick  crust.  Below 
this  were  several  superficial  excoriations.  There  were  many  contusions 
on  other  parts  of  the  body.  Tardieu  concluded  that  the  mark  on  the 
neck  was  from  attempt  to  strangle;  the  wounds  elsewhere  to  prevent 
resistance.  She  had  at  the  time  pulmonary  consumption.  She  died  of 
this  disease  aggravated  by  the  assault. 

67.  Ibid.,  p.  106. — The  Duroulle  afi'air.  Woman  found  hanging. 
Presumption  of  homicide;  arrest  of  husband;  acqixitted.  She  was 
found  with  her  face  to  the  fioor,  one  end  of  a  cord  around  her  neck; 
another  similar  cord  attached  seven  feet  above  to  a  rafter,  over  which 
it  passed  three  times.  Bidault  and  Boulard  reported  it  a  suicide.  The 
results  of  the  post  mortem  weii^as  follows:  Skin  of  a  red-violet  color; 
face  swollen;  eyes  prominent  and  congested;  conjunctivae  a  vinous 
red ;  lips  violet;  tongue  swollen,  tip  between  teeth;  froth  in  air-pas- 
sages; lungs  congested;  brain  congested;  blood  fluid.  Circular  de- 
pression around  neck  with  congestion  of  skin  above  and  below;  ecchy- 
mosis  in  subcutaneous  tissue  on  level  of  angle  of  jaw  and  about  one 
centimetre  in  size,  supposed  to  correspond  to  the  knot.  Tardieu  re- 
ported that  the  marks  rather  resembled  those  of  strangulation  than 
hanging;  the  ecchymoses  were  more  like  those  produced  by  the  hand 
over  the  mouth.  The  marks  on  the  face  supposed  to  have  been  made 
by  a  supposed  fall  of  the  body  were  by  him  considered  to  have  been 
caused  by  violence.  He  believed  the  woman  had  been  strangled  and 
then  hung. 

68.  Ibid.,  p.  130. — The  Daugats  afPair.  Man  found  hanging,  sitting 
on  the  ground,  head  and  trunk  somewhat  inclined  to  the  left;  legs 
stretched  out;  clothing  not  disordered;  the  part  of  the  cord  which  was 
around  the  neck  was  applied  to  the  neck  of  the  waistcoat  and  shii't:  on 
his  head  a  woollen  cap.  The  ground  had  been  recently  swept.  Necro- 
scopy twenty-four  hours  afterward.  Face  pale;  right  eye  open  and 
prominent,  left  closed ;  mouth  closed,  contained  food  apparently  from 


ILLUSTRATIVE   CASES — HOMICIDE.  769 

the  stomach;  tongue  retracted;  shglit  mark  on  neck  under  which  the 
tissue  was  normal;  atlas  dislocated  on  axis,  but  tissues  around  were 
normal;  no  lesion  in  spinal  canal;  penis  not  erect;  moisture  having- 
the  odor  of  urine  on  the  shirt;  large  ecchymosis  and  infiltration  of  left 
cheek;  extensive  contusions  on  scrotum,  with  hemorrhagic  infiltration, 
especially  around  right  testicle.  Veins  of  head  engorged  with  black 
fluid  blood.  Brain  normal.  Some  black  fluid  blood  in  right  cavities 
of  heart,  left  side  empty.  Lungs  black.  Other  organs  normal. 
Causse  and  Orfila  concluded  that  the  man  had  been  suffocated  and 
then  hung.  The  wife  and  son  confessed  that  they  had  injured  the 
testicle  through  the  pantaloons;  he  then  fainted;  they  then  suffocated 
him  with  the  woollen  cap  placed  over  the  mouth  and  nose:  the  son 
kneeled  on  the  man's  belly,  the  body  was  then  hung  up  and  the  head 
violently  twisted. 

69.  Passauer :  Viert.f.  ger.  Med.  und  off.  San.,  1870,  xxiv.,2)p-  26- 
49. — Woman  found  hanging  in  a  kneeling  position.  The  ligature  on 
the  neck  was  loose.  The  necroscopy  showed  the  following:  Tongue 
between  the  teeth;  eyelids  swollen  and  livid;  livid  spots  on  face  and 
left  ear;  lower  lip  torn;  a  number  of  marks  on  neck;  one  red  stripe 
not  sharply  limited;  skin  not  parchmenty  and  no  ecchymosis;  ecchy- 
moses  of  scalp;  periosteum  of  skull  reddened;  hemorrhage  in  tem- 
poral muscle ;  brain  and  pia  mater  congested;  much  fluid  in  ven- 
tricle. Larynx  and  trachea  dirty  red -brown;  right  side  of  heart 
empty ;  a  little  dark  fluid  blood  in  left;  great  vessels,  including  aorta, 
containing  much  dark  fluid  blood.  Lungs  congested  and  ccdematous. 
Liver,  spleen,  and  kidneys  congested.  Wpinion  given  that  she  died  of 
asphyxia  and  was  either  choked  or  hanged.  Reference  to  Royal  Col- 
lege of  Medicine,  Konigsberg,  where  the  opinion  was  given  that  she 
died  of  injuries  on  head  and  neck  and  was  afterward  hanged. 

70.  Becker:  Same  journal,  1877,  xxvii.,  pp.  463^73. — Woman, 
age  52;  found  hanging.  Death  caused  by  shock  and  incipient  asphyxia 
from  strangulation  and  probably  the  wounds  on  head  and  limbs. 

71.  Maschka:  '' Samm.  gericht.  Gutacht.,^'  etc.  (Prag),  Leipzig, 
1873,  published  a  number  of  interesting  cases,  in  each  of  which  there 
was  a  question  raised  as  to  the  cause  of  death. 

72.  Ibid. ,  p.  127.— Man  found  dead.  Had  he  been  strangled  or  hung, 
or  had  he  died  some  other  way  ?  Opinion,  death  from  paralysis  of  the 
brain. 

73.,  Ibid.,  p.  133.— Woman,  age  42;  found  hanging;  a  mark  around 
her  neck.  Did  she  hang  herself  or  die  of  other  injuries  ?  Opinion,  died 
of  other  injuries. 

74.  Reh7n:  Friedreich's  Bldtt.,  1883,  xxxiv.,  pp.  322-362.— Man, 
age  73;  found  hanging.  Opinion,  while  weak,  sick,  and  suffering  from 
wounds  inflicted  by  his  own  son,  he  was  hanged  by  his  daughter-in- 
law. 

49 


770  HANGING — LAMB. 

75.  Hofmann:  ''  Lehrbuch,^^  p.  538. — A  father  hung  his  five  chil- 
dren, the  eldest  9  years.  Another  man  hung  two  children,  the  eldest 
13  years. 

See  also  Tidy,  "Med.  Juris.,"  Cases  40,  48,  51,  57  (?),  58  (?);  "Hang- 
ing after  Death,"  Case  50. 


Judicial  Hanging. 

76.  MacLaren:  Indian  Med.  Gaz.,  1873,  vin.,p.  234. — Three  cases 
of  judicial  hanging;  hung  at  the  same  time  and  cut  down  and  necro- 
scopy begun  forty  minutes  afterward;  drop  twelve  inches.  In  the  first 
and  third  there  were  reflex  movements  for  a  few  minutes  after  drop  fell. 
First  man,  age  40;  pupils  slightly  dilated;  no  protrusion  of  tongue 
or  eyeballs;  mark  of  cord  above  thyroid  cartilage;  no  discharge  of 
semen  or  faeces;  ecchymosis  under  cord,  left  side;  dislocation  of  atlas 
from  axis;  odontoid  ligaments  ruptured;  transverse  ligament  unin- 
jured. Brain  and  membranes  miich  congested;  clear  fluid  in  lateral 
ventricles.  Lungs  collapsed,  anaemic;  one  ounce  straw-colored  serum 
(measured)  in  pericardium;  dark  fluid  blood  in  both  ventricles  of  heart; 
liver  much  congested. 

77.  Second  man,  age  16;  pupils  widely  dilated;  eyeballs  protruding. 
Marks  of  cord  same  as  in  preceding  case.  No  discharge  of  fseces  or 
semen.  No  ecchymosis  under  cord;  dislocation  and  rupture  of  liga- 
ments between  axis  and  third  vertebra.  Brain  did  not  show  well- 
marked  congestion.  Lungs  %)llapsed  and  anaemic.  One  and  one- 
quarter  ounces  serum  (measui^ed)  in  pericardium.  Heart  normal;  dai'k 
blood  in  both  venti'icles;  liver  normal. 

78.  Third  man,  age  20;  pupils  slightly  dilated;  eyeballs  and  tongue 
not  protruded.  Marks  of  cord  as  in  preceding.  No  discharge  of  faeces 
or  semen.  Slight  ecchymosis  under  cord;  mark  in  front  of  neck.  Dis- 
location of  occipital  bone  from  atlas.  Brain  and  membranes  much 
congested.  Lungs  collapsed  and  anaemic.  Half  ounce  serum  in  peri- 
cardium. Heart  normal;  dark  fluid  blood  in  both  ventricles;  liver 
normal. 

79.  Cayley:  Ibid.,  p.  122. — Man,  age  35;  executed  by  hanging. 
Scarcely  any  convulsive  movements  after  drop  fell.  Necroscopy  two 
hours  afterward.  No  congestion  or  protrusion  or  swelling  of  the 
tongue;  no  muscular  rigidity  or  contractions.  About  half-way  around 
the  neck  was  indentation  of  cord,  obliquely  directed;  hardly  perceptible 
in  front;  its  surface  appeared  rubbed  and  compressed;  no  discoloration; 
no  ecchymosis  under  skin.  Cord  lay  aci'oss  upper  part  of  thyi'oid  car- 
tilage. Larynx  and  trachea  not  injured.  Fracture  and  dislocation  of 
upper  cervical  vertebrae.  Lungs  collapsed,  not  congested.  Pericar- 
dium empty;  heart  distended,  left  side  with  red  blood  just  beginning 


ILLUSTRATIVE   CASES— JUDICIAL   HANGING.  771 

to  clot;  rig-lit  side  with  fluid  black  blood.     Liver  and  other  abdominal 
organs  much  congested.     No  discharge  of  fseces  or  semen. 

80.  Garden:  Same  journal,  1880,  xv.,  p.  12. — Man,  age  40,  weight 
about  one  hundred  and  twenty  pounds;  drop  two  feet;  was  in  a  faint- 
ing condition,  and  had  to  be  supported;  was  not  probably  fully  con- 
scious when  platform  fell.  Thei-e  were  spasmodic  retractions  of  arms 
and  legs  for  about  two  minutes;  forty  seconds  after  the  dro])  lusjnngeas 
fell  off;  his  penis  was  in  strong  erection,  and  the  ejaculatoiy  move- 
ments were  seen.  Necroscopy  one  and  one-quarter  houi's  after  drop 
fell.  Head  and  limbs  cold;  eyes  open,  natural;  tongue  not  protruding; 
fingers  clinched;  superficial  veins  contained  fluid  black  blood.  Mark 
of  cord  extended  from  just  below  left  mastoid  process,  where  tbe  knot 
was  applied,  across  the  thyrohyoid  membranes  to  a  place  on  right  side 
about  two  inches  below  ear.  There  was  .scarcely  a  trace  of  it  behind. 
Skin  dark  and  ecchymosed,  but  no  ecchymosis  of  subcutaneous  con- 
nective tissues.  No  discoloration  nor  fracture  in  neck.  Subarachnoidal 
fluid  in  excess;  puncta  vasculosa  unusually  numerous.  Under  surface 
of  epiglottis  reddened  and.  showed  two  small  dark  red  ecchymoses; 
mucous  membrane  of  larynx  and  trachea  pale.  Lungs  showed  venous 
congestion;  no  infarctions  or  small  ecchymoses;  right  lung  emphyse- 
matous; the  left  showed  old  firm  adhesions  throughout.  Heart  large, 
flabby,  pale,  a  very  little  blood  in  each  ventricle;  subpericardial  ecchy- 
mosis one-fourth  inch  square  anteriorly,  another  larger  one  posteriorly; 
extensive  pericardial  adhesions.     Liver  and  kidneys  congested. 

81.  See  two  cases  of  judicial  hanging  by  Wilkie,  same  journal, 
1881,  xvi.,  p.  275. 

82.  Porter:  Archiv.  Laryngol.,  New  York,  1880,  i.,p.  142. — Rede- 
mier  hung.  Drop  five  feet.  Pulse  beat  rapidly  a  few  minutes,  then 
lessened  in  frequency  and  stopped  beating  in  fifteen  minutes.  During 
this  time  there  was  violent  spasm  of  muscles  of  thorax  and  upper  limbs. 
Necroscopy,  dark  groove  around  neck  crossing  larynx  just  below 
po^nmn  Adami.  Brain  congested.  Lvmgs  emphysematous.  Cricoid 
cartilage  fractured  diagonally.  Laryngeal  mucous  membrane  showed 
ecchymosis  and  oedema.     Vertebrae  neither  fractured  nor  dislocated. 

83.  Another  criminal  hung  at  the  same  time  had  dislocation  of 
cervical  vertebrae. 

84.  Femvick:  Canada  Med.  Jozir.,  1867,  Hi.,  p.  195.— Man  exe- 
cuted; drop  six  feet;  second  cervical  vertebra  torn  from  attachment  to 
third;  medulla  torn  across;  hyoid  bone  and  tongue  torn  from  thyroid 
cartilage;  general  congestion  of  viscera;  lenses  normal ;  eyes  congested; 
clot  between  sclerotic  and  choroid  coats  left  eye. 

85.  Dyer:  Trans.  Amer.  Ophthal.  Soc,  1866,  p.  13.— Man,  age  24; 
weight  one  hundred  and  seventy-four  and  a  half  pounds;  drop  three 
feet;  knot  under  loft  ear;  for  two  minutes  at  intervals,  slight  motion 
of  abdomen,  like  effort  at  respiration,  and  at  same  time  knees  drawn 


772  HANGING — LAMB, 

up  a  little.  Death  speedy  and  quiet.  Cut  down  at  end  of  thirty 
minutes.  Necroscopy  thirty-five  minutes  after  drop.  Body  and  head 
moist  and  warm;  emission  of  semen;  face  livid;  upper  lid  discolored; 
abrasion  of  skin  under  right  ear;  deep  red  mark  around  neck.  Eye- 
balls not  prominent;  eyelids  closed;  corneae  dull;  pupils  a  little  dilated. 
Both  lenses  fractured.  Brain  normal;  spinal  cord  normal.  Heart 
empty. 

86.  Dyer:  Same  Trans.,  1869,  pp.  72-75. — Man  hung.  One  eye 
showed  fracture  of  lens,  the  other  lens  showed  fine  lines.  A  second 
case  showed  dislocation  of  a  cataractous  lens.  A  third  showed  fissure 
of  lens. 

87.  Green:  Same  Trans.,  1876,  p.  354. — Man  hung;  drop  seven  or 
eight  feet.  Died  quietly  and  without  struggle.  One-half  to  one  hour 
after  drop  fell,  eyes  were  examined.     No  lesion  of  capsule  or  lens. 

88.  Keen:  Amer.  Jour.  Med.  Sci.,  1870,  lix.,p.  417. — Two  criminals 
hung;  drop  five  feet.  Hyoid  bone  fractured  in  one;  no  fracture  of 
vertebrae  in  other. 

89.  Clark:  Boston  Med.  and  Surg.  Jour.,  1858,  Iviii.,  p.  480. — 
Execution  of  Magee.  Man,  age  28;  weight  130  pounds.  Drop  seven  to 
eight  feet.  No  struggle  nor  convulsion.  Urine  discharged  at  once. 
Seven  minutes  after  drop  fell,  heart-beat  one  hundred;  nine  minutes, 
ninety-eight;  twelve  minutes,  sixty  and  fainter;  fourteen  minutes,  not 
audible;  twenty -five  minutes,  body  lowered.  Face  purple;  puj)ils  dilat- 
ed; eyes  and  tongue  did  not  protrude.  Mark  of  cord  just  above  thyroid 
cartilage,  a  deep  oblique  furrow  except  a  small  space  under  left  eai*; 
knot  over  mastoid  process.  Forty  minutes,  cord  and  strap  removed; 
body,  especially  face,  became  paler.  Necroscopy  a  little  over  an  hour 
after  drop  fell.  Body  pale;  skin  mottled;  small  ecchymosis  just  above 
line  of  cord  right  side.  Right  sterno-mastoid  muscle  torn.  Hyoid 
bone  fractured;  spine  not  injured.  No  seminal  dischai^ge.  Ninety  min- 
utes, pulsation  in  right  subclavian  vein;  heart -beat,  eighty  per  minute; 
thorax  opened,  heart  exposed;  right  auricle  showed  full  and  regular 
contractions  and  dilatations.  The  spinal  cord  was  then  divided.  One 
hundred  and  twenty  minutes,  heart-beats  forty  per  minute.  These 
pulsations  of  right  auricle  continued  at  intervals  for  three  and  a  half 
hours  longer;  readily  excited  by  point  of  scalpel.  Heart  normal;  left 
ventricle  contracted;  right  ventricle  not  so;  no  coagulation.  Brain 
normal;  lungs  collapsed;  liver  and  spleen  congested;  mucous  mem- 
brane of  small  intestine  pinkish;  other  organs  normal.  In  the  discus- 
sion, Dr.  Gay  thought  the  absence  of  cerebral  congestion  was  due  to 
the  circulation  continuing  in  the  left  carotid. 

90.  Hofm,ann:  Wien.  med.  Woch.,  1880,  xxx.,  pp.  477-480. — Man, 
a  ci'iminal,  hung;  after  hanging  ten  minutes,  the  body  was  cut  down. 
Examination  half -hour  after  drop  fell.  He  was  resuscitated  and  partly 
regained  consciousness,  but  died  three  days  afterward  of  oedema  of 


ILLUSTRATIVE   CASES — JUDICIAL   HANGING.  773 

lungs  after  repeated  severe  convulsions.  He  liad  tumors  of  the  neck 
which  probably  interfered  with  the  compression  of  the  trachea.  See 
also  Allg.  Wien.  med.  Zeit.,  1880,  xxv.,  p.  161,  and  Wien.  med.  Bliit., 
1880,  i.,  pp.  423-430;  translated  in  Ann.  Mai.  Oreill.  and  Larvnx, 
Paris,  1880,  vi.,  pp.  99-112. 

91.  Kinkhead:  Lancet,  1885,  l,  pp.  657,  658,  and  701-703.— Causes  of 
hanging.  In  one,  the  body  of  the  third  cervical  vertebra  was  Ijroken 
across  and  the  two  pieces  separated;  in  another  case  dislocation  of  sec- 
ond and  third  cervical  vertebrae. 

92.  Nelson:  Southern  Clinic,  1885,  viii.,  pp.  198-202.— Two  col- 
ored men  hung;  drop  five  feet.     In  one  there  was  atlo-axoid  dislocation. 

93.  Dercum:  Phila.  Med.  Times,  1886-87,  xvii.,p.  368.— Descrip- 
tion of  the  brain  of  a  man  executed  by  hanging. 

94.  Kirtikar:  Trans.  M.  and  P.  Soc,  Bombay,  1885,  vi.,pp.  104- 
107. — Man,  age  25,  and  woman,  age  35.  Both  hanged.  Droj)  nine  feet. 
Knot  tied  over  cricoid  cartilage,  a  little  to  left  side.  In  falling,  the 
knots  slipped  to  below  the  ear.  There  was  fracture  of  the  body  of  third 
cervical  vertebra  and  rupture  of  ligaments.  The  cord  was  ruptured 
in  each;  in  the  woman  in  two  places — once  at  the  third  cervical,  the 
other  at  the  dorso-lumbar  junction. 

95.  Lamb:  Med.  Netvs,  Philadelphia,  1882,  xli.,pp.  42-45.— Exe- 
cution of  Guiteau.  Drop  six  feet;  knot  placed  under  left  ear,  but 
slipped  to  back  of  head.  Yellowish  furrow  a  few  lines  wide  around 
the  neck,  directed  downward  and  forward.  Sterno-mastoid  muscles 
torn  transversely  about  midway  of  their  length.  Thyro-hyoid  ligament 
ruptured;  hyoid  bone  and  thyi'oid  cartilage  widely  separated.  Large 
blood-vessels  not  injured.     No  fracture  or  dislocation  of  vertebrae. 

96.  Thomson  and  Allen :  Catalog.  Surg.  Sec.  Ai^ny  Med.  Mus.  ; 
specimens  298  to  302. — Execution  of  Wirtz.  Rope  one-half  inch  diam- 
eter; drop  five  feet;  knot  under  left  ear.  Several  slight  shrugs  of 
shoulders,  after  which  body  was  quiet;  let  down  in  fifteen  minutes. 
No  involuntary  evacuation.  Face  pale,  placid.  Eyes  partly  open; 
pupils  dilated;  slight  injection  of  conjunctivae.  Mouth  open;  tongue 
not  protruding.  Just  above  thyroid  cartilage  extending  on  right  side 
from  median  line  in  front  to  spinous  process  was  a  dirty  brown  deep 
furrow  with  congested  walls;  on  left  side  a  line  of  discoloration  due  to 
direct  action  of  rope.  Soft  parts  above  and  below  the  line  much  swol- 
len, particularly  on  right  side.  Larynx  and  hyoid  bone  unnaturally 
mobile.  Right  trajiezius  muscle  torn;  sterno-ma.stoid  divided  ti-ans- 
versely,  leaving  an  interval  of  two  inches.  Slight  ecchymoses  between 
muscle  and  larynx.  Ecchymoses  on  ligamentum  nuchas.  Hyoid 
bone,  both  greater  cornua  fractured  and  dislocated  from  body;  lesions 
more  marked  on  right  side.  Several  small  ecchymoses  in  vicinity. 
Larynx  not  injured.     Brain  normal.     No  bloody  or  frothy  mucus  in 


774  STJPFOCATION — LAMB. 

air-passages.  Lungs  not  congested.  One  drachm  of  straw-colored 
serum  in  pericardium.  Heart  empty.  Abdominal  organs  normal. 
Bladder  somewhat  distended  with  urine. 

See  also  Tidy,  "Med.  Juris.,"  Cases  1  to  4  '^,nd  60. 

Accident. 

97.  Harvey :  Indian  Med.  Gaz.,  1876,  xi.,  p.  3. — Boy,  ageli  years; 
was  swinging  by  two  ropes  attached  to  two  posts;  the  ro^jes  became 
twisted  around  his  neck.  Necroscopy  showed  mark  of  very  small  rope 
in  front  of  neck  from  ear  to  ear;  mucous  membrane  of  larynx  dark; 
lungs  much  congested. 

98.  HacJcel:  Op.  cit.,  p.  35. — Man,  age  19,  sitting  on  a  load  of 
wood,  with  the  lines  around  his  neck,  fell  and  was  hung  by  the  lines. 

99.  Biggs  and  Jenkins:  New  York  Med.  Jour.,  1890,  lii.,  p.  30. 
— Case  16;  child,  6  months  old,  sitting  on  a  high  chau%  fell  between 
the  chair  guard  and  seat  and  was  asphyxiated  by  compression  of  neck. 

See  also  Tidy  (op.  cit.),  Cases  53  and  54. 


SUFFOCATION. 

The  term  suffocation  is  applied  in  a  special  sense  to  the  act 
and  condition  of  preventing  access  of  air  in  other  ways  than 
by  pressure  on  the  neck,  as  b}^  pressure  on  the  chest,  b}^  obstruc- 
tion at  the  mouth  or  nose,  by  obstruction  in  the  air-passages  or 
on  them  from  neighboring  organs,  by  irrespirable  gases,  etc. 

This  article  will  consider  all  of  these  except  drowning  and 
irrespirable  gases,  which  are  treated  of  elsewhere  by  other 
writers. 

Smothering  is  generally  understood  to  mean  the  act  and 
effect  of  stopping  the  mouth  and  nose. 

Causes. 

External  Causes.— Overlaying  is  a  frequent  cause  of 
suffocation  in  infants,  which  in  such  cases  have  usually  occu- 
pied the  same  bed  with  one  or  both  parents.  In  some  cases  the 
parents  have  been  drunk  or  otherwise  unable  to  prevent  the 
injury,  and  the  infant  may  also  be  partly  stupefied  with  the 
alcohol  derived  from  its  mother's  milk.  Infants  are  also  some- 
times overlaid  by  domestic  animals.  Again,  they  have  been 
suffocated  by  being  pressed  too  closely  to  the  mother's  breast,  or 


CAUSES.  _  775 

by  covering  with  bedclothes,  shawls,  etc.  Noble'  attributes  some 
cases  of  asphj-xia  in  the  new-born  to  anaemia  of  the  brain  from 
pressure  on  the  skull  by  forceps,  etc.,  and  recommends  as  treat- 
ment for  this  condition  hanging  the  child  head  downward, 
so  that  the  blood  may  gravitate  to  the  brain  (Cases  12  and  30). 

Infants  are  sometimes  smothered  for  mercenary'  purposes. 

Persons  have  been  suffocated  by  the  pressure  of  a  crowd. 
Pressure  on  the  chest  combined  with  forcible  closure  of  the 
mouth  and  nose  was  the  method  of  Burke  and  Williams,  in 
the  notorious  burking  murders,  (Case  58).  The  close  applica- 
tion of  a  hand,  cloth,  or  plaster  over  nose  and  mouth  is  of  itself 
sufficient  to  cause  suffocation,  especially  in  children  and  feeble 
persons.  Pressure  on  the  abdomen  crowds  up  the  diaphragm 
and  interferes  with  breathing.  It  is  very  likely  that  no  exter- 
nal mark  will  be  found  in  cases  of  pressure  on  the  chest  and 
abdomen,  but  the  lungs  will  be  marbled  and  emphysematous. 

Taking  plaster  casts  of  the  face  and  neck  without  inserting 
tubes  in  the  nostrils  has  caused  death  in  some  cases.  Suffoca- 
tion often  follows  the  falling  of  walls,  houses,  banks  of  earth, 
piles  of  coal  or  corn  or  wheat.  One  may  fall  into  and  be  im- 
bedded in  some  mobile  substance  as  coal,  wheat,  corn,  quick- 
sand, or  nightsoil,  and  be  suffocated.  Infants  have  been  de- 
stroyed "  by  burying  them  in  manure,  ashes,  bran,  etc.  In  these 
cases  there  is  not  only  the  entrance  of  the  foreign  body  into 
the  air-passages,  but  the  pressure  of  the  mass  against  the  chest 
and  abdomen. 

Internal  Causes. — The  air-passages  ma}'  be  closed  up  by 
foreign  bodies  within  them,  or  within  adjoining  organs,  espe- 
cially the  oesophagus.  A  great  variety  of  substances  in  one  of 
these  two  ways  has  caused  suffocation :  mud,  cotton,  rags,  corn, 
meat,  beans,  pepper,  potato  skins,  the  fang  of  a  tooth,  artificial 
teeth,  buckles,  shells,  flint,  buttons,  screws,  crusts  of  bread, 
bones,  fruit,  stones,  heads  of  grass,  coins,  slate  pencils,  nuts, 
nut-shells,  shot,  penholders,  worms,  fish,  etc.  (see  Cases  6  and 
55).  Taylor  ^  states  that  there  were  eighty-one  deaths  in  one 
j-ear  in  England  and  Wales  from  food  in  the  air-passages. 

Should  an  inspiration  occur   in   the   act  of  vomiting,  the 

'  Amer.  Jour.  Obstet.,  1886,  xix.,  -Tardicni,  op.  cit.,  p.  291. 

pp.  349-352.  =*"Med.  Jur.,"  Am.    ed.,  1892,  p. 

428. 


776  SUFFOCATION— LAMB. 

vomitus  may  pass  into  the  air-passages ;  a  similar  accident  may 
occur  in  a  person  who  attempts  to  swallow  and  speak  at  the 
same  time.  Infants  have  been  suffocated  by  inspiring  vomited 
milk.  Fitz  '  states  that  food  may  pass  from  the  digestive  tube 
to  the  air-passages  after  death. 

A  case  of  suffocation  in  an  infant  by  retraction  of  the  base 
of  the  tongue  is  recorded.  It  has  been  stated  that  negroes  have 
committed  suicide  by  doubling  back  the  tongue  into  the  throat, 
or,  as  it  is  called,  swallowing  the  tongue.^  In  giving  anaes- 
thetics, the  subject  being  supine,  and  the  head  and  neck  some- 
what flexed,  the  tongue,  epiglottis,  and  soft  palate  may  fall 
backward  and  suffocation  may  follow.  Howard  ^  states  that 
pulling  the  tongue  forward  under  such  circumstances  may 
reopen  the  pharynx,  but  will  not  lift  the  epiglottis.  The  thorax 
should  be  raised  and  head  and  neck  extended  backward.  He 
believes  that  in  giving  ansesthetics  the  head  should  be  lower 
than  the  shoulders.  In  order  to  avoid  vomiting  no  food  should 
be  taken  for  some  hours  before  the  anaesthetic. 

Cases  are  recorded  of  artificial  teeth  having  fallen  from  the 
mouth  into  the  air-passages  during  anaesthesia  and  sleep,  and 
in  epileptic  and  puerperal  convulsions.  It  would  appear  advis- 
able that  these  teeth  should  be  worn  only  while  eating  (Case 
13). 

Hemorrhage  from  the  lungs,  from  rupture  of  an  aneurism 
or  from  injury  of  the  mouth  or  throat,  may  make  its  way  into 
the  air-passages  and  cause  suffocation.  So  also  the  bursting  of 
an  abscess  of  the  tonsils  or  other  part  near  the  air-passages 
(Case  7). 

CEdema  of  the  glottis  from  scalding  or  other  irritation  of 
the  fauces  or  glottis,  or  from  disease  of  the  kidneys;  tumors 
pressing  on  some  portion  of  the  air-passages;  rapid,  profuse 
bronchial  secretion  in  infants ;  acute  double  pleuritic  effusion ; 
cheesy  glands  ulcerating  into  trachea ;  simultaneous  oedema  of 
both  lungs — all  of  these  may  cause  suffocation  (Cases  18  and  40) . 
[For  cases  of  enlarged  thymus  gland,  see  Hofmann,  op.  cit., 
pp.  587,  588.] 

Paralysis  of  the  muscles  of  swallowing,  from  diphtheria  or 

'  Trans.  Mass.  Leg.  Soc,  1878,  i.,  -See  Ogston,  p.  550. 

pp.  14-24.  3  Med.  Times  and  Gaz.,  1878,  i.,  p. 

603. 


CAUSES — SYMPTOMS.  777 

other  cause,  predisposes  to  suffocation.  Progressive  asthenia 
in  which  the  muscles  are  exhausted;  injurj-  of  spinal  cord  or 
pneumogastrics ;  paralysis  of  muscles  of  respiration  from  the 
use  of  curare ;  the  spasms  of  tetanus  and  strychnia  poisoning ; 
the  entrance  of  air  into  the  pleural  cavities  with  collapse  of  the 
lungs — all  tend  to  cause  mechanical  suffocation  either  by  pres- 
sure or  by  paralysis  (for  deaths  in  epileptics,  see  Cases  1,  10, 
11,  33,  and  40). 

It  is  not  necessary  that  the  air-passages  should  be  abso- 
lutely closed  to  cause  suffocation. 

The  cause  of  death  is  more  likely  to  be  pure  asphj'xia,  be- 
cause of  the  absence  of  the  complicating  pressure  of  the  hand  or 
ligature  on  the  vessels  and  nerves  of  the  neck,  and  of  fracture 
of  larynx  or  vertebrae. 

Symptoms. — Foreign  bodies '  entering  the  trachea  natu- 
rally fall  toward  the  right  bronchial  tube  instead  of  the  left 
because  of  the  size  and  position  of  the  entrance  of  the  right 
tube.  If  then  but  one  tube  is  involved,  the  signs  will  usually 
be  on  the  right  side ;  whereas  if  the  foreign  body  stop  in  the 
larynx  or  trachea,  both  sides  will  be  affected.  The  latter  con- 
dition is  much  more  dangerous.  The  symptoms  would  be 
resonance  over  the  lung  with  the  respiratory  murmur  partly  or 
wholly  absent ;  less  mobility ;  puerile  breathing  on  the  unaffected 
side.  In  either  case  there  may  at  first  be  little  disturbance, 
especially  if  the  shape  of  the  foreign  body  is  such  as  not  to 
greatly  interfere  with  the  access  of  air;  otherwise  there  maj-  be 
at  once,  and  almost  alwaj^s  will  be  after  a  time,  more  or  less 
urgent  dyspnoea.  Diminution  of  the  necessary  oxygen  ma}* 
cause  convulsions,  apoplexy,  and  other  brain  symptoms.  Acute 
emphysema  of  the  portion  of  lung  not  obstructed  may  follow 
its  forcible  distention.  The  local  effect  of  the  foreign  body  is 
an  irritation  which  causes  spasm  and  cough.  It  may  be  car- 
ried upward  by  the  expirations  and  downward  again  by  each 
inspiration.  Inflammation  is  likely  to  appear  eventually  and 
may  involve  the  lung.  If  the  obstruction  is  not  complete  there 
may  follow  periods  of  alternation  of  good  and  bad  health,  end- 
ing perhaps  in  recovery.  The  foreign  body  may  be  expelled 
after  a  greater  or  lesser  interval.  On  the  other  hand  death  may 
result  from  secondary  causes.  In  the  absence  of  correct  his- 
'  Johnson,  Lancet,  1878,  ii.,  p.  501. 


778  SUFFOCATION — LAMB. 

tory  the  symptoms  may  lead  to  a  wrong  diagnosis  and  inappro- 
priate treatment ;  as  where  a  patient  whose  symptoms  resulted 
from  the  presence  of  a  piece  of  bone  in  the  larynx,  was  treated 
for  syphilis.  A  foreign  body  may  be  coughed  up  from  the 
lung  into  the  trachea  and  fall  backward  into  the  opposite  lung. 

Partial  closure  of  the  larynx,  most  likely  caused  by  a  flat  or 
irregular  substance,  rather  than  globular,  may  cause  gradual 
asphyxia  with  symptoms  of  apoplexy,  making  the  diagnosis 
difficult. 

When  a  foreign  body  remains  a  long  time  in  the  larynx, 
spasmodic  cough  aiid  croupy  breathing  usually  ensue,  expec- 
toration tinged  with  blood,  hoarseness,  or  complete  aphonia, 
pain,  dyspnoea,  possibly  crepitation  and  dulness  over  the  lungs. 
The  case  may  end  suddenlj'  in  death  from  closure  of  the 
glottis,  or  the  foreign  body  may  pass  into  the  trachea  and  set 
up  a  new  train  of  sj^mptoms,  or  it  may  be  expelled. 

The  frequency  with  which  foreign  bodies  in  the  pharjmx 
or  oesophagus  obstruct  respiration,  and  the  facility  with  which 
they  may  usually  be  removed,  suggest  a  careful  examination. 
Otherwise  the  patient  may  be  treated  indefinitely  for  supposed 
obstruction  in  the  air-passages.  Foreign  bodies  in  the  oesoph- 
agus have  perforated  into  the  trachea,  and  even  the  lungs, 
heart,  and  aorta. 

In  complete  suffocation  death  Avill  occur  in  from  two  to  five  minutes 
(see  remarks  under  Strangulation).  Death  may  also  occur  instanta- 
neously. 

The  experiments  of  the  Committee  on  Suspended  Animation' 
showed  that  when  the  trachea  of  a  dog  was  exposed,  incised,  and  a 
tube  tied  in,  the  average  time  covered  by  the  respiratory  efforts  after 
stop])ing  \iY>  the  tube  with  a  cork  was  four  minutes  five  seconds;  the 
heart-beat  stopping  at  seven  minutes  eleven  seconds  on  tlie  average. 
After  four  minutes  ten  seconds  it  seemed  to  be  impossible  for  the  dog, 
unaided,  to  recover.  Faure  -  made  the  following  experiment  upon  a 
large  dog:  He  fixed  a  cork  in  the  trachea.  At  first  the  dog  was  quiet; 
it  then  extended  its  neck,  parted  its  jaws,  and  made  efforts  as  if  to 
vomit;  tlien  tried  to  walk,  but  its  gait  was  uncertain;  fell  do^vn  and 
rose  up.  Its  eyes  became  dull,  and  finally  it  fell  down  on  its  side,  and 
became  convulsed;  then  after  several  seconds  stretched  itself  out.  The 
thoracic  movements  were   at  first  tumultuous,  then  became  rapidly 

'Med.-chir.  Trans.,  1862,  xlv. ,  p.  -Archiv.  gen.  de  Med.,  1856,  vii., 

449.  p.  300. 


SYMPTOMS — TREATMENT.  779 

feeble;  the  heart  beating  very  slowly.  At  the  necroscopy  the  lungs 
filled  the  thorax,  were  full  of  thick  dark  blood  and  emphysematous. 
The  blood  was  black  and  fluid  in  the  left  ventricle  and  arteries^  and  in 
the  right  cavities  and  veins  resembled  molasses.  Liver  darkly  con- 
gested. There  was  no  mucus  in  the  trachea  and  no  ecchymosis  in 
the  lungs.  He  also  (p.  306)  tried  the  experiment  upon  a  large  dog  of 
fastening  boards  against  its  thorax  and  tightening  them  by  means  of 
cords.  For  some  minutes  it  was  quiet,  but  suddenly  it  became  much 
agitated,  stood  upon  its  hind  legs,  threw  itself  against  the  wall,  rolled 
on  the  ground,  and  uttered  frightful  cries;  finally  fell  on  its  side. 
There  was  no  movement  of  the  thorax,  but  the  muscles  of  the  neck 
and  belly  were  in  full  and  rapid  action,  dry  and  sonorous  rales  were 
heard,  and  a  large  quantity  of  mucus  appeared  at  the  nose  and  mouth. 
The  movements  grew  feebler,  the  respirations  infrequent,  and  at  the 
end  of  thirty-four  minutes  it  was  dead.  The  necroscopy  showed  the 
blood  black  and  thick;  heart  x'elaxed;  lungs  red,  a  little  emphyse- 
matous, containing  bvit  little  blood,  and  on  their  surface  were  blackish 
points  and  small  red  spots. 

The  death  of  Desdemona  (Shakespeare's  "Othello")  has  been  much 
criticised.  The  declaration  that  she  was  strangled  (or  suffocated)  does 
not  consist  with  the  symptoms  described  (see  3Ied.  Neivs,  Philadel- 
phia, May  1st,  1886,  p.  489). 

Treatment. 

The  obvious  indication  is  to  search  for  and  remove  the 
obstruction.  The  means  and  methods  of  treatment  are  fully 
treated  of  in  surgical  works,  but  may  be  briefly  mentioned  here. 

Laryngoscopical  examination  may  be  necessarj".  A  curved 
forceps  is  usually  the  best  instrument  for  removing  the  foreign 
body.  A  tallow  candle  may  serve  to  push  it  into  the  stomach 
if  there  is  no  bougie  at  hand.  Suction  maj"  be  used.  Sneezing 
may  be  brought  on  by  tickling  the  nostrils;  coughing  by  tick- 
ling the  glottis;  vomiting  by  irritating  the  fauces,  or  by  emetic; 
the  body  of  the  subject  may  be  inverted  and  in  this  position  the 
fauces  ma}'  be  tickled,  or  fingers  may  bo  passed  back  into 
the  pharynx.  Johnson  '  says  that  at  the  moment  of  inversion 
the  patient  should  try  to  take  a  deep  inspiration;  this  opens  the 
glottis  and  facilitates  the  expulsion  of  the  foreign  body.  The 
inspiratory  current  has  no  appreciable  effect  in  retarding 
the  movement  of  the  foreign  body  in  the  direction  of  gravit}'. 

Noble  recommends  inversion  of  the  body  in  new-born  infants 
'Op.  cif.,  p.  539. 


780  SUFFOCATION — LAMB. 

in  which  asphyxia  may  be  supposed  to  be  due  to  anaemia  of  the 
brain.  Tracheotomy  or  laryngotomy  may  be  necessary.  It 
may  be  necessary  to  administer  oxygen.  Foreign  bodies  Hke 
beards  of  grass  and  iSsh-heads  can  be  withdrawn  only  with  diffi- 
culty because  of  their  sharp  projections.  Intense  suffering  and 
dyspnoea  in  a  robust  subject  may  necessitate  venesection.  Gen- 
erally speaking  it  is  better  to  bring  up  the  foreign  bcdy  than  to 
push  it  down  into  the  stomach.  Beveridge  suggests  to  blow 
into  the  ear,  to  induce  a  reflex  action  and  cause  expulsion  of 
the  foreign  body.  Cold  affusions,  artificial  respiration,  galvan- 
ism, frictions  of  the  limbs,  artificial  heat,  stimulants  by  mouth 
and  rectum,  may  one  or  all  be  needed. 

Hamilton '  says  that  it  is  useless  to  expect  good  results 
from  electricity  if  five  minutes  have  elapsed  since  life  ap- 
peared to  be  extinct;  Althaus,"  that  three  hours  after  death 
the  muscles  will  cease  to  respond  to  faradization;  and  Rich- 
ardson,'  that  a  low  temperature  prolongs  the  sensitiveness  of 
the  muscle. 

With  regard  to  insufflation,  Le  Bon*  objects  to  it  in 
asphyxia  as  being  hurtful  and  not  useful.  Colin  ^  tamponed 
the  trachea  of  a  horse;  in  four  minutes  fifty  seconds  it  was 
apparently  dead;  the  tampon  was  removed  and  insufflation 
practised  for  fifteen  to  twenty  minutes  without  effect.  He 
claims  that  artificial  respiration  is  useless  after  the  circulation 
ceases. 

Fell*  and  O'Dwj^er'  recommend  forced  inspiration. 
McEwen  *  uses  a  tracheal  tube  by  the  mouth. 

Dew  ®  offers  a  new  method  of  artificial  respiration  in  asphyxia  of 
the  new-born;  Lusk  '"  considers  the  subject  of  life-sa'ST.ng'  in  still-bnths; 
Forest,'*  artificial  respiration  in  the  same;  Read ''^  discusses  Schultze's 
method  with  approval;  Duke  '^  plunges  the  infant  into  hot  water;  Rich- 

i^'Amer.    Pract.,"  1872,   vi.,  pp.  ^Brit.   Med.  Jour.,   1880,   ii.,  pp. 

193-206.  122-124  and  163-165. 

2  Brit.  Med.  Jour.,  1879,  i.,  p.  970.  » Med.   Rec,   N.   Y.,  1893,  xliii., 

^ "  Nature, "  1879,  xx. ,  p.  108.  p.  289. 

*Gaz.   hebd.    Med.,    Paris,    1872,  '"Amer.    Jour.    Med.    Sci.,    1891, 

ix.,  p.  806.  ci.,  pp.  109-116. 

'^Bull.  Acad.  Med.,    Paris,    1876,  "Coll.   and  Clin.    Record,    1892, 

v.,  p.  764.  xiii.,  pp.  170-173. 

*Jour.    Amer.    Med.    Ass.,    1891,  ''^  Glasgow  Med.  Jour.  ,1885,  xxiv., 

xvi.,  p.  805.  pp.  344-354. 

'Trans.    Amer.   Tsed.   Soc,  1891,  '^j^led.    Press    and    Circ,     1889, 

iii.,  pp.  128-132.  xlviii.,   p.  433. 


POST-MORTEM   APPEARANCES.  781 

ardson  >  recommends  artificial  circulation  by  injection  of  vessels,  or 
electric  excitation;  Jennings^  recommends  the  same;  Richardson  ^  also 
considers  fully  the  subject  of  artificial  respiration  and  electrical  excita- 
tion; Woillez^  has  described  and  recommended  what  he  cal is  a  spiro- 
phore. 

After  the  removal  of  a  foreign  body  the  irritation  remaining 
may  cause  a  sensation  as  if  the  body  was  still  lodged. 
Death  may  occur  from  hemorrhage  after  its  removal. 

PosT-MoRTEM  Appearances. 

These  are  mainl}'  those  of  asphyxia.  There  may  also  be 
evidences  of  external  violence,  homicidal  or  accidental,  as  of 
pressure  on  the  chest.  Persistent  deformity,  flattening  of  the 
nose  and  lips,  and  excoriation  of  these  parts  may  result  from 
forcible  closure  of  mouth  and  nose. 

The  SKIN  and  CONJUNCTIVA  usually  show  patches  of  livid- 
ity  and  punctif orm  ecchymoses ;  especially  lividity  on  the  lips 
and  limbs.  The  face  may  be  pale  or  violet;  it  is  often  placid, 
especially  if  the  suffocation  is  accidental.  Tardieu  ^  admits 
that  infiltration  of  the  conjunctiva  and  punctif  orm  ecchymoses 
of  the  face,  neck,  and  chest  ma}^  also  be  found  sometimes  in 
women  after  severe  labor,  and  in  epileptics.  He  records  the 
result  of  the  examination  of  those  who  died  from  suffocation  at 
the  Pont  de  la  Concorde,  18GG.  The  face  and  upper  parts  of 
the  trunk  were  generally  light  red  to  a  deep  violet  or  black 
color,  with  punctated  blackish  ecchymoses  on  the  face,  neck, 
and  upper  part  of  chest. 

The  eyes  are  usually  congested.  Mucus  and  sometimes 
bloody  froth  are  found  about  the  NOSE  and  mouth.  The 
TONGUE  may  or  may  not  protrude. 

The  BLOOD  is  usually  dark  and  very  fluid.  Wounds  after 
death  may  bleed.  According  to  Tardieu  "  fluidity  of  the  blood 
is  most  constant  in  compression  of  the  chest  and  abdomen,  as 
also  its  accumulation  in  the  vessels  and  right  side  of  heart. 
Its  color  varies  from  red  to  black. 

754,  904;  and  1881,  x., 


'Asclepiad,  1885.  ii.,  pp.  171-187. 

v.,  pp.  611,  754,  9( 

2  Lancet,    1885,    1.,    pp.    245-347, 

pp.  847-852. 

289-292. 

''Op.  cit.,  p.  279, 

^Asclepiad,  1890.  vii..p.  201. 

"  Op.  cit.,  p.  288. 

4  Bull.   Acad.   Med.,    Paris,  1876, 

782  SUFFOCATION— LAMB. 

The  BKAix  and  pia  mater  are  generally  congested.  This  is 
said  to  be  invariable  if  the  eyes  are  congested.  Mackenzie  in 
thirteen  cases  found  the  brain  congested  in  all. 

The  HEART  varies  much  in  appearance  and  condition.  The 
right  side  is  often  fall  of  blood;  occasionally  empty.  Some- 
times subpericardial  ecchymoses  are  found,  usually  along  .the 
coronary  vessels.  The  blood  in  the  heart  may  be  partly  coag- 
ulated if  the  agony  has  been  prolonged  and  there  has  been  a 
partial  access  of  air,  which  is  gradually  diminished.  Mackenzie  ' 
found  the  right  cavities  full  and  the  left  empty  in  nine  out  of 
thirteen  cases.  Johnson  ^  as  a  result  of  experiment  on  animals 
claims  that  when  access  of  air  is  prevented  there  is  a  rise  in 
pressure  in  the  arteries,  the  right  side  of  the  heart  fills,  the 
pulmonary  capillaries  become  empty,  and  therefore  the  left  side 
of  the  heart  becomes  empty.  As  a  result  of  further  experi- 
ments '  lie  verified  his  former  conclusion,  and  added  that  in  the 
last  stage  of  asphyxia  there  is  increased  pressure  on  the  pul- 
monary artery  and  lessened  pressure  in  the  systemic  vessels. 
He  thinks''  that  when  both  sides  of  the  heart  contain  blood, 
there  is  paralysis  of  vaso-motor  nerves  and  the  arteries. 

The  TRACHEA  is  usually  bright  red  and  often  contains  bloody 
froth.  The  larynx  or  trachea  as  well  as  pharynx  or  cesoph- 
AGUS  may  contain  a  foreign  body.  If  the  latter  has  been 
removed  the  resulting  irritation  may  be  seen.  The  lungs  are 
sometimes  congested,  at  others  normal;  color  red  or  pale. 
Sometimes  one  lung  only  is  affected.  Thej^  maj'  be  emphyse- 
matous. Mackenzie  found  them  congested  in  all  of  thirteen 
cases  examined  by  him.  The  lungs  of  young  persons  may  be 
found  comparatively  small,  almost  bloodless,  and  emphj^sema- 
tous.  Tardieu,  Albi,  a,nd  others  believed  that  the  p?mc/(/"o;';>i 
subpleural  ecchymoses  indicated  suffocation,  and  were  due  to 
small  hemorrhages  from  engorged  vessels  which  ruptured  in 
the  efforts  at  expiration.  These  spots  are  usually  round,  dark, 
from  the  size  of  a  pin-head  to  a  small  lentil,  and  well  defined. 
The3^  are  not  like  the  petechise  in  the  lungs  and  heart  after  pur- 
pura, cholera,  eruptive  fevers,  etc.,  nor  like  the  hemorrhages 
under  the  scalp  after  tedious  labor,  all  of  which  are  variable  in 

'  Indian  Med.    Gaz. ,    1890.    xxv. ,  ^Ih.,  1891,  p.  399. 

P-  257.  4  Lancet,  1889.  ii.,  p.  255. 

-  Brit.  Med.  Jour. ,  1877,  i . ,  p.  444. 


POST-MORTEM   APPEARANCES.  783 

size.  These  punctiform  spots  are  usually  seen  at  the  root, 
base,  and  lower  margin  of  the  lungs.  Hofmann  states  ("  Lehr- 
buch")  that  they  are  found  in  the  posterior  part  of  the  lungs  and 
in  the  fissures  beween  the  lobes.  They  are  indisputably  fre- 
quent after  death  from  suffocation,  and  if  well  marked  either  in 
adults  or  infants  that  have  breathed,  the}'^  indicate  suffocation, 
unless  some  other  cause  of  death  is  clear.  Simon,-  Ogston,  and 
Tidy,  however,  have  shown  that  they  are  sometimes  absent  in 
fatal  suffocation,  and  are  sometimes  present  in  the  absence  of 
suffocation,  as  after  hanging  and  drowning;  in  foetuses  before 
labor  has  begun ;  often  in  still-births,  although  some  of  these 
are  probablj'  due  to  suffocation  from  inhaling  fluid  or  from 
pressure.  Also  in  death  from  scarlet  fever,  heart  disease,  apo- 
plexy, pneumonia,  and  j)ulmonary  oedema.  Grosclaude  '  quotes 
from  Pinard,  who  declares  that  these  ecchymoses  are  found  in 
foetuses  which  die  from  arrest  of  circulation.  Grosclaude  him- 
self made  a  large  number  of  experiments  on  animals  by  drown- 
ing, hanging,  and  strangling,  and  fracturing  the  skull.  The 
ecchymoses  were  found  in  nearly  all  the  cases. 

The  ecchymoses  are  partly  the  result  of  venous  stasis,  which 
overcomes  the  resistance  of  some  capillaries;  and  the  latter 
rupture,  parti}'  from  the  aspirating  action  of  the  thoracic  wall, 
the  lung  being  unable  to  fill  itself  with  air,  but  mainl}-'^  from 
vaso-motor  contraction  and  lateral  pressure  at  the  maximum 
of  the  asphyxia,  the  time  of  tetanic  expiration.  If  the  asphyxia 
is  interrupted  before  this  stage,  the  spots  do  not  appear.  Simi- 
lar ecchymoses  ma}' be  found  under  the  scalp,  in  the  tympanum, 
retina,  nose,  epiglottis,  larynx,  trachea,  thymus,  pericardium, 
in  the  parietal  pleura,  along  the  intercostal  vessels,  rarely  the 
peritoneum,  in  the  stomach,  and  sometimes  the  intestines;  and 
in  other  parts  of  the  body,  especially  the  face,  base  of  neck,  and 
front  of  chest;  in  convulsive  affections,  as  eclampsia  and  epi- 
lepsy, and  in  the  convulsions  of  strychnia  and  prussic  acid 
poisoning  there  may  be  suffusion  and  congestion  of  the  lungs 
though  not  the  punctated  spots. 

Mackenzie,  in  thirteen  cases  of  suffocation  from  various 
causes,  failed  to  find  the  Tardieu  spots  either  externally  or  in- 
ternally.    Briand  and  Chaude'  state  that  they  are  less  con- 

'  Paris  thesis,  1877,  No.  327.  ^"Med.  Leg.,"  1874,  p.  406. 

» Hofmann,  "  Lehrbuch, "  p.  514. 


784  SUFFOCATION — LAMB. 

stant  and  characteristic  in  those  who  have  been  buried  in 
pulverulent  substances. 

Ogston  '  holds  that  in  infants  that  are  smothered  the  ecchy- 
moses  are  found  in  greater  number  in  the  thymus  gland ;  while 
in  adults  dying  from  other  forms  of  asphyxia  they  were  found 
only  once  in  that  gland.  The  spots  are  found  in  clusters  in 
infants  that  are  smothered,  but  only  single  and  scattered  in 
adults  who  die  from  drowning,  hanging  or  disease.  They  were 
wanting  in  the  lungs  of  but  one  infant. 

They  may  be  recognized  as  long  as  the  lung  tissue  is  un- 
changed. The  apoplectic  spots  in  the  lungs  seen  in  strangula- 
tion are  not  found  in  suffocation. 

Tardieu  ^  from  experiments  on  animals  and  examination  of  twenty- 
three  new-born  infants  who  showed  traces  of  violence  around  the 
month,  found  the  lungs  rather  pale  and  aneemic,  subpleiiral  ecchymo- 
ses  well  marked.  All  the  deaths  were  rapid.  In  cases  of  compression 
of  chest  and  abdomen  ^  the  congestion  of  the  lungs  was  extensive,  and 
pulmonary  apoplexy  frequent;  more  so  than  in  other  forms  of  suffoca- 
tion. He  gave  strychnia  to  animals  which  died  in  convulsions,  and 
found  very  irregular  and  partial  congestions,  generally  not  marked  be- 
cause death  was  so  prompt;  blood  always  fluid;  no  subpleural  ecchy- 
moses. 

The  LIVER,  SPLEEN,  and  kidneys  are  generally  congested; 
the  kidney  more  than  the  other  organs  named.  The  spleen 
is  said  to  be  often  anaemic.  Semen  has  sometimes  been  found, 
unexpelled,  in  the  urethra. 

Page  *  experimented  on  three  kittens,  suffocating  them  in  cinders. 
The  post-mortem  examinations  showed  the  veins  engorged,  left  side 
of  heart  empty,  right  side  full  of  dark,  half -clotted  blood.  Lungs  dis- 
tended, much  congested,  color  violet;  many  small  fluid  hemorrhages 
in  substance;  no  subpleural  ecchymoses.  Frothy  mucus  tinged  with 
blood  in  trachea  and  bronchi;  bronchi  congested.  Bi*ain  and  abdom- 
inal organs  normal. 

Proof  of  Death  by  Suffocation. 

It  is  sometimes  difficult  in  a  given  case  to  state  whether 
death  is  due  to  suffocation.  There  is  no  lesion  which  of 
itself  could  be  accepted  as  proof.     But  a  collation  of  the  lesions 

'  Op.  cit. ,  p.  554.  3  Qp   cif. ,  p.  288. 

-  Op.  cit. ,  p.  275.  ■*  Ojx  cit. ,  p.  2.S. 


PROOF  OF  DEATH  BY  SUFFOCATION.  785 

found  taken  in  connection  with  the  surroundings  of  the  body 
will  in  many  if  not  in  most  cases  lead  toa  definite  conclusion. 

Infants  have  been  found  alive  four  and  five  hours  after 
having  been  buried  in  the  earth.'  If  the  pulverulent  material 
has  penetrated  into  the  oesophagus  and  stomach,  the  burial  has 
occurred  during  life.  Exceptionally  when  burial  has  occurred 
after  death  and  traces  of  the  material  are  found  in  the  air- 
passages,  thej'  are  not  found  in  the  oesophagus  or  stomach. 

The  committee  on  "Suffocation,"  of  the  New  York  Med.  Leg.  See, 
reiJortecP  the  following  group  of  appearances  as  evidences  of  deatli  by 
suffocation:  The  general  venous  character  of  the  blood,  the  turgidity 
of  the  larger  veins,  the  congestion  of  the  ijarenchyniatous  organs, 
especially  at  the  base  of  the  brain,  the  lungs  congested  in  a  variable 
degree  and  cedematous,  frothy  mucus  in  the  bronchi,  the  right  side  of 
the  heart  alwaj's  fuller  than  the  left.  Fitz  ^  holds  that  suffocation  is  a 
condition  comiDOsed  of  a  group  of  symptoms  and  aj^pearances  due  most 
probably  to  accumulation  of  carbon  dioxide  in  the  blood  and  a  defi- 
ciency of  oxygen.  The  appearances  are:  The  blood  dark  and  fluid 
(though  in  gi-adual  suffocation  there  may  be  clots  in  the  right  side  of 
the  heart),  the  right  side  of  the  heart  full,  venous  congestion  of  the 
lungs  (not  constant),  interstitial  emj)hysema  of  the  lungs,  and  venous 
congestion  of  the  liver,  kidneys,  and  brain.  He  prefers  the  word  en- 
gorgement to  congestion  in  this  connection. 

Tardieu  *  holds  that  when  in  infants  buried  in  pulverulent 
substances  we  find  emphj'sema  of  the  lungs  in  high  degree, 
bloody  froth  in  the  air-passages,  abundant  subpleural  and  sub- 
pericardial  ecchymoses  and  the  blood  fluid,  the  burial  has  oc- 
curred during  life.  The  same  lesions  are  found  in  small  ani- 
mals similarly  treated. 

It  must  not  be  forgotten  that  an  intoxicated  person  or  one 
in  an  epileptic  spasm  is  practically  helpless,  and  can,  therefore, 
be  suffocated,  accidentally  or  otherwise,  under  circumstances 
in  which  one  in  possession  of  his  senses  would  be  able  to  escape. 

Accidental,  Homicidal,  and  Suicidal  Suffocation. 

Accidental  sufEbcation  is  frequent,  as  has  already  ap- 
peared. Suicidal  suflFocation  is  very  rare.  Homicidal 
suffocation  occurs.     Foreign  bodies  have  been  forced  into  the 

'Tardieu,  op.  cit.,  pp.  296,  398.  ^-jrans.     Mass.    Med.    Leg.    Soc, 

2 Physician,     etc.,     New  York,      1878,  i..  pp.  14-24. 
1880,  xiii.,  p.  181.  *  Op.  cit.,  p.  291. 

50 


780  SUFFOCATION — LAMB. 

air-passages.  Smothering  has  been  done  by  holding  the  face 
in  various  materials  to  prevent  access  of  air ;  by  pressure  on 
the  chest;  by  forcible  closure  of  the  mouth  and  nose  as  in  burk- 
ing; by  laying  compresses  over  the  face,  as  in  the  case  of 
King  Benhadad, '  whom  Hazael  killed.  "  And  it  came  to  pass 
on  the  morrow  that  he  took  a  thick  cloth  and  dipped  it  in 
water,  and  spread  it  over  his  face,  so  that  he  died ;  and  Hazael 
reigned  in  his  stead."  Benhadad  was  already  quite  ill  and  not 
expected  to  live. 

Death  by  suffocation ''  may  be  considered  as  presumptive  of 
homicide  unless  the  facts  are  already  referable  to  accident. 

In  infants,  suffocation  is,  of  course,  either  accidental  or 
homicidal ;  in  adults  usually  accidental.  The  absence  of  signs 
of  a  struggle  in  adults  suggests  accident ;  unless  there  is  cause 
of  suspicion  of  previous  stupefying  with  narcotics. 

Taylor '  calls  attention  to  a  dangerous  practice  among  some 
attendants  upon  infants,  of  putting  into  the  mouth  of  the  child 
to  quiet  it  a  bag  containing  sugar;  and  instances  a  case  in 
which  the  child  would  have  died  of  suffocation  but  for  the  for- 
tunate discovery  of  a  part  of  the  bag  protruding  from  the 
mouth. 

In  ten  years,  3,612  deaths  were  reported  in  the  city  of 
London,  of  infants  smothered  by  being  overlaid." 

Infants  may  be  born  into  a  mass  of  blood  and  fseces,  from 
which  the  unattended  mother  in  her  weakness  may  be  unable 
to  remove  them. 

Page  *  shows  by  experiment  that  tlie  inspiratory  effort  when  violently 
exerted  is  sufficient  to  convey  small  .  objects  into  the  air-passages. 
Cinders  passed  thus  into  the  trachea  and  oesophagus  of  kittens  and 
rabbits.  Berenguier®  experimented  on  new-born  pups,  i^lacing  them 
in  ashes,  plaster,  and  starch.  In  ashes  they  lived  fifteen  hours;  these 
found  their  way  into  the  middle  of  the  oesoi^liagus,  but  were  stopped  at 
the  glottis.  Plaster  and  starch  formed  a  paste  with  the  oral  mucus 
and  the  movement  of  the  mass  was  not  so  great  as  the  ashes.  In  no 
case  did  either  of  the  materials  pass  beyond  the  glottis.  Tardieu  ^  ex- 
amined three  infants  which  had  been  buried  during  life.  One  was  in 
ashes;  the  nose  was  obstructed,  mouth  full:  ashes  also  in  the  cesoplia- 

'  Second  Kings,  viii.,  15.  ^  Op.  cit.,  p.  31. 

-Tavlor,  op.  cit.,  p.  482.  ^  Jour,  de  Med.  de  Toulouse,  1851, 

■Wp.  cit.,  p.  434.  iii.,  p.  237. 

••Tavlor.  "Med.   Jin-.,"  Am.  ed.,  Wp.cit.,-p.  295. 

1880,  p.  485. 


ILLUSTRATIVE   CASES — ACCIDENTAL.  787 

gus  and  stomach,  but  none  in  larynx  or  bronchi.  The  second  infant 
was  in  manure;  a  greenish  stuff  was  found  in  the  mouth  and  stomach. 
The  third  in  bran  (confessed  to  by  the  mother);  the  nose  and  mouth 
were  full,  but  there  was  none  in  the  throat;  a  few  grains  in  the  trachea. 
Tardieu  experimented  on  rabbits  and  Guinea  pigs  by  burying  them  in 
bran,  sand,  and  gravel,  some  of  them  being  alive  and  the  others  dead. 
In  those  buried  alive  he  found  the  substance  filling  the  mouth  and 
nose  to  the  base  of  the  tongue;  in  most  of  the  cases  the  oesophagus  and 
trachea  were  not  f)enetrated.  In  the  animals  fu'st  killed  and  then 
buried,  the  substance  had  not  passed  into  the  mouth  or  nose.  In  one 
case  only  he  found  ashes  in  the  larjaix  and  trachea  of  a  rabbit  which 
had  been  buried  many  hours  after  death  in  a  box  of  ashes.  Matthyssen  ' 
held  a  Guinea  pig,  head  downward,  with  its  nose  under  mercury;  the 
lungs  were  full  of  globules  of  mercury  (which  has  a  specific  gravity  of 
13.5).  A  dog  was  plunged  head  first  into  liquid  plaster-of -Paris;  the 
plaster  was  found  in  the  bronchial  tubes. 

ILLUSTRATIVE   CASES. 

Accidental. 

1.  Huppert:  Vier.  ger.  Med.  und  off.  San.,  1876,  xxiv.,  pp.  237- 
252. — Two  cases.  A  man  choked  by  piece  of  bread  in  pharynx.  Sec- 
ond, an  epileptic,  suffocated  by  flexion  of  chin  on  larynx.  In  both 
cases  seminal  fluid  was  found  in  urethra  near  meatus,  unexpelled;  de- 
termined by  microscope. 

2.  Johnson:  Lancet,  1878,  ii.,  p.  501. — Boy  swallowed  penny,  be- 
came black  in  face;  eyeballs  protruded;  symptoms  soon  subsided. 
Some  hours  afterward  it  was  found  that  he  could  not  swallow  solids, 
and  liquids  only  with  difficulty  and  coughing.  Tlu-oat  much  irritated; 
discharge  of  mucus  sometimes  tinged  with  blood,  from  mouth;  moist 
rattling  noise  in  throat  in  respiration;  frequent  cough;  could  not  sleep. 
LarjTigoscope  showed  penny  in  upper  pai-t  of  oesophagus,  just  below 
lar.\^lgeal  opening.     Removed  by  long  curved  forceps. 

3.  Ihid. — Man  suddenly  fell  while  at  dinner;  face  blue;  breathing 
stertorous.     Died.     Piece  of  tendon  found  under  epiglottis. 

4.  Ibid.— Boy,  age  5  years.  Button  in  larynx.  Aphonia,  dyspnoea, 
stridulous  breathing.  Distress  gradually  subsided.  Many  years  after- 
ward found  mucous  membrane  of  larynx  thickened;  vocal  cords  red 
and  uneven. 

5.  Ibid. — Man,  drunk,  swallowed  a  half-sovereign.  Urgent  dysp- 
noea; pain  in  throat;  aphonia;  stridulous  breathing;  dysphagia;  cough; 
copious  mucous  expectoration.  Laiyngoscopic  examination  showed 
coin  in  oesophagus.  The  crico-thyroid  membrane  was  incised  and  coin 
pushed  upward  and  ejected. 

'Ann.  d'Hyg.;  1840,  xxx. .  p.  '225. 


788  SUFFOCATION — LAMB. 

6.  Med.  Times  and  Gaz.,  1874,  i.,  p.  486. — Man,  age  20,  had  severe 
dyspnoea.  In  taking-  a  living  fish  in  his  teeth  (it  was  about  four  inches 
long  and  had  large  dorsal  fin),  the  fish  passed  into  the  pharynx  and  lay 
doubled  up.  Impossible  to  remove  it  because  of  spines.  Tracheotomy 
at  once.  Twenty-four  hours  afterward  the  fish  had  decomposed  enough 
to  be  partly  removed.     Patient  died  of  exhaustion. 

7.  Littlejohn:  Edin.  Med.  Jour.,  1875,  xx.,p.  780. — Woman  found 
dead  in  bed.  SuflPocated  by  pus  from  abscess  of  tonsil  which  burst 
during  sleep.  Found  pus  in  air-passages  down  to  smallest  bronchi; 
lungs  congested;  right  side  of  heart  distended  with  dark  fluid  blood; 
left  side  contracted  and  neai-ly  empty.  Blood  everywhere  fluid.  Some 
lividity  of  face.  The  woman  had  died  quietly  lying  beside  her  hus- 
band, who  was  not  awakened. 

8.  Say  re:  Neio  York  Med.  Jour.,  1874,  xix.,  p.  420. — Girl,  age  7, 
swallowed  a  bead.  Had  continuous  cough;  much  pain  under  midtUe 
of  sternum.  The  bead  moved  upward  and  downward  in  resph-ation. 
Tracheotomy.  Four  days  afterward  she  coughed  the  bead  out,  in- 
sjDired  once,  and  apparently  died.  Artificial  respiration  used:  alcohol 
injected  into  rectum;  galvanization  of  phrenic  nerves.  She  finally 
coughed  up  a  piece  of  thick  mucus  and  recovered. 

9.  Duffy:  Trans.  Med.  Soc.  No.  Car.,  1874,  p.  126.— Boy,  age  8, 
swallowed  a  cow-pea.  It  lodged  in  the  trachea.  Some  months  after- 
ward, laryngotomy  performed.  The  boy  seemed  to  die  at  once.  Arti- 
ficial respiration  used.  After  a  while  he  expelled  first  some  mucus, 
then  the  pea.     RecoA^ered. 

10.  Tardieu:  Op.  cit.,  p.  290. — Man,  age  50,  found  dead  on  the 
floor.  At  base  of  neck  and  front  of  chest  were  many  punctated  ecchy- 
moses.  Brain  and  lungs  much  congested;  the  latter  showed  subpleural 
spots.  Tongue  and  lips  bitten.  Death  was  due  to  cerebral  and  pul- 
monary congestion  from  an  epileptic  seizure. 

11.  Oesterlen:  Vier.  f.  ger.  Med.  und  off.  San.,  1876,  xxiv.,x>.  10. 
— "Woman,  age  30,  epileptic.  Found  dead.  Examination  showed  signs 
of  asphyxia;  blood-vessels  engorged,  marked  oedema  of  lungs,  etc. 
Opinion  given  that  she  died  in  epileptic  paroxysm,  and  certain  injuries 
observed  were  caused  by  a  fall. 

12.  Tardieu:  Op.  cit.,  p.  322. — Two  childi-en,  one  2  months  old, 
the  other  18  months  old;  in  bed  together.  The  older  overlay  the 
younger,  which  died.  Necroscopy:  kings  voluminous,  in  places  con- 
gested, in  others  j)ale;  abundant  subpleural  ecchymoses;  quite  emphy- 
sematous.    Fluid  blood  in  heart. 

13.  Blum:  New  York  Med.  Jour.,  1885,  xlii.,  p.  207. — Woman, 
found  dead.  Vulcanite  plate  of  usual  size,  with  four  teeth  attached, 
found  wedged  in  trachea  about  two  inches  below  lar}^lx. 

14.  Wyeth:  Same  journal,  1884,  xl.,  p.  487. — Boy,  age  12,  inspired 
a  pin-dart  in  trjdng  to  blow  it  through  a  blowgun.     Violent  cough. 


ILLUSTRATIVE   CASES — ACCIDENTAL.  789 

gasping  for  breath,  lividity  of  face  for  a  few  minutes;  sjTiiiDtoms  sub- 
sided leaving  slight  cough.  The  dart  had  lodged  in  right  bronchus 
beyond  first  bifurcation,  as  shown  by  hissing,  fluttering  sound  in  both 
inspu'ation  and  expiration.  Tracheotomy.  The  dart  could  not  be 
reached.  At  a  later  date  the  dart  was  brought  up  into  the  mouth  by  a 
strong  expiration. 

15.  Partridge:  Same  journal,  1890,  IL,  p.  303. — Child,  4  months 
old,  found  dead;  fluid,  partly  digested  milk  in  air-pa.ssages. 

16-41.  Biggs  and  Jenkins:  Same  journal,  1890,  Hi.,  p.  30. — Re- 
port of  many  cases  of  fatal  suffocation  from  foreign  bodies,  etc.  Boy, 
age  15 — collar-button  in  larynx  .Boy,  age  10 — mass  of  butter  in  larynx. 
Boy,  age  5 — bronchial  gland  discharged  into  trachea  at  bifurcation. 
Boy,  age  3 — screw  in  larynx.  Boy,  age  5 — rubber  balloon  with  whistle 
attached;  it  was  partly  inflated  with  each  expiration.  Girl,  age  10 — 
a  "jack  "  in  larynx.  Man,  age  45 — had  been  di'inking  freely;  piece  of 
meat  in  larjaix.  Man,  age  40 — piece  of  meat  in  larynx  and  pharynx. 
Man,  age  40 — ditto.  Insane  patient — piece  of  meat  in  trachea.  Man — 
piece  of  meat  in  larjTix.  Man,  age  40 — crackei'S  and  cheese  in  larynx. 
Child — rubber  nipple  in  larynx.  During  administration  of  ether,  pa- 
tient vomited;  vomitus  entered  larynx.  Two  children  in  bed  asleep; 
one,  3  years  old,  overlay  the  face  of  the  younger,  age  5  months.  Wo- 
man, age  25,  exoileptic — fell  on  a  child  and  smothered  it.  Two  children 
found  dead,  covered  with  bedclothing.  Man,  age  21,  epileptic — found 
lying  on  his  face  in  bed.  Girl,  age  12,  epileptic — ditto.  Woman,  age 
21 — ditto.  Girl,  age  18 — ditto.  Woman,  age  35,  epileptic— fell  on  the 
floor.  Woman,  age  28 — ditto.  Man,  age  35,  epileptic;  vomited  while 
in  spasm;  vomitus  entered  larjaix.  From  Dr  Janeway :  Man,  epilep- 
tic, fell  on  his  face  in  pile  of  manure,  which  entered  larynx.  Man, 
drunk,  li^dng  on  his  face. 

42.  Roy.  Indian  Med.  Gaz.,  1880,  xv.,  p.  71. — Man,  believed  to  be 
drunk,  had  vomited  in  bed  ;  vomitus  entered  trachea  and  bronchi. 

43-47.  Mackenzie:  Same  journal,  1890,  xxv.,p.2^7. — Reports  fatal 
cases  :  Boy — bone  button  in  larynx.  Sailor — meat  in  larjaix.  Boy 
— vomited  matter  in  larynx.  Infant — while  taking  the  breast,  a  rush 
of  milk  suddenly  filled  the  air-passages.  Also  three  cases  of  crushing 
under  walls;  two  buried  in  loose  earth;  two  crushed  in  a  crowd;  one 
by  bags  of  grain. 

48.  Feulard:  Bidl.  Soc.  Anat.,  1883,  viii.,  pp.  384-386. — Woman, 
age  79.  Piece  of  beef  in  larynx.  Necroscopy  showed  hematoma  in 
dura  mater. 

49.  Poupon:  Bidl.  Soc.  Clin.,  Paris  (1882),  1883,  vi.,  pp.  236-238. 
— Boy,  age  5^  years.     Death  from  cheesy  gland  in  trachea. 

50.  Pons:  Jour.  Med.,  Bordeaux,  1889-1890,  xix.,  2ip.  57-61.— 
Woman,  age  24.  Death  from  CBdema  of  larynx  from  presence  of  par- 
ticles of  food. 


790  SUFFOCATION — LAMB. 

51.  Kemeny :  Wien.  med.  Blat.,  1890,  xiii.,  p.  37. — Man,  age  45. 
Suffocated  by  curdled  milk  in  air-passages. 

52.  Maschka:  Vier.  ger.  Med.,  1885,  xliii.,  pp.  11-14. — Man,  age 
65.     Accidental  compression  of  chest. 

53.  Heidenhain:  Same  journal,  1886,  xliv.,  pp.  96-101. — Vomited 
matter  passed  into  air-passages  while  subject  was  drunk. 

54.  Langstein:  Wien.  med.  Woch.,  1880,  xxx.,  pp.  624-626. — 
Child  found  dead  in  bed;  had  vomited  food  while  asleep  and  breathed  it 
into  air-passages. 

55.  Ward:  Catalog.  Army  Med.  Mus.,  Med.  Sec,  p.  S3. — Soldier, 
age  17;  choked  to  death  by  lumbricoid  worm  passing  from  pharynx  into 
right  bronchus.     Specimen  7,737. 

Suicide, 

56.  Sankey:  Brit.  Med.  Jour.,  1883,  i.,  p.  88.— Epileptic;  found 
dead  in  bed,  lying  on  his  back.  A  round  pebble  in  each  nostril;  strip 
of  flannel  rolled  up  and  stuffed  in  throat. 

57.  Macleod:  Ibid.,  1882,  ii.,  p.  1246. — Suicidal  maniac.  Had  to 
be  fed  because  he  refused  food.  Was  seen  to  be  blue  in  the  face  and 
breathing  hard.  His  mouth  was  forced  open;  roll  of  flannel  found  in 
throat.  Macleod  refers  to  another  case,  a  woman  in  dissecting-room, 
with  similar  roll  of  flannel  in  throat. 

See  Tidy,  "Med.  Jur.,"  Cases  15  to  17. 

Homicide. 

58.  Christison:  Edin.  Med.  Jour.,  1829,  xxxi.,  pp.  236-250.— The 
famous  Burking  case.  A  woman  was  struck  down  to  a  sitting  posture. 
Burke  then  threw  himself  on  her,  kept  her  down  by  the  weight  of  his 
body,  covered  her  mouth  and  nose  with  one  hand  and  placed  his  other 
hand  under  the  chin  for  ten  to  fifteen  minutes,  till  she  died.  Neci-o- 
scopy  showed  a  severing  of  the  posterior  ligamentous  connections  of 
the  third  and  fourth  cervical  vertebrae,  with  blood  in  spinal  canal  but 
not  under  the  dura  mater;  cord  not  injured.  Chiistison  made  experi- 
ments to  ascertain  if  the  injury  to  spine  had  been  made  during  life, 

59.  Hackel:  Dorpat  Diss.,  1891,  p.  35.— Case  of  choking  with  pres- 
sure on  breast  and  belly.  Woman  found  lying  on  floor,  Avith  many 
injuries. 

60.  Tardieu:  Op.  cit.,  p.  315.— New-born  infant;  found  buried  in 
earth.  Mother  stated  that  the  child  had  not  breathed.  Putrefaction 
had  begun.  There  was  a  brownish  tint  of  skin  of  upper  front  part  of 
neck  below  jaw;  drops  of  sanious  fluid  flowing  from  nose;  umbili- 
cal cord  had  not  been  tied;  subcutaneous  hemorrhage  in  right  temporal 
region;  brown  bruised  surface  and  contused  wounds  of  pharynx,  where 


ILLUSTRATIVE   CASES — SUICIDE   AND    HOMICIDE.  791 

particles  like  ashes  and  vomited  niatter  were  found.  Lungs  filled  the 
pleural  cavities,  were  rose-colored  and  showed  abundant  jiunctated 
subpleural  ecchymoses;  bloody,  frothy  mucus  in  trachea  and  bronchi; 
some  serum  in  pericardium;  respu-ation  had  been  complete.  Opinion 
given,  that  the  infant  had  been  suffocated  by  obstruction  of  pharjoix, 
probably  by  fingers. 

61.  Tardieu:  Op.  cit.,  p.  323. — New-born  infant  found  under  a 
cask,  partly  eaten  by  a  dog.  The  head  showed  transverse  flattening 
and  svibcutaneous  hemorrhage.  Lungs  voluminous,  rosy;  abundant 
subpleural  ecchymoses;  hemorrhage  in  left  lung.  Heart  filled  with 
fluid  blood.  Coagulated  blood  in  abdomen.  Opinion  given,  suffoca- 
tion by  jDressure  on  head,  chest,  and  abdomen.  The  mother  confessed 
that  she  had  placed  the  child  under  the  cask. 

62.  Ibid.,  p.  325. — New-born  infant  found  buried  in  the  earth;  gravel 
and  earth  in  pharynx  and  oesophagus  down  nearly  to  stomach,  and  in 
trachea  and  right  bronchus.  Lungs  congested,  crepitant.  Opinion 
given,  that  the  child  had  been  buried  while  living. 

63.  Ibid.,  p.  326. — New-born  infant  found  in  ashes;  nose  and  lips 
ohstructed,  mouth  filled;  ashes  in  oesophagus  and  stomach;  none  in 
lar^^lx  or  trachea.  Lvxngs  distended  with  air,  emphysematous;  sub- 
pleural ecchymoses;  fluid  blood  in  heart. 

64.  Ibid.,  p.  327. — New-born  infant,  buried  in  bran;  nose  and  mouth 
filled;  some  in  trachea;  none  in  oesophagus  or  stomach.  Lungs  dis- 
tended with  air,  emphysematous;  subpleural  ecchjonoses;  heart  empty. 

65.  Devergie  and  Raynaud:  Ann.  dHyg.,  1852,  xlviii.,  pp.  187- 
206. — Man  found  dead  on  a  pile  of  grain;  mouth,  no.se,  and  eyes  con- 
tained some  of  the  grain;  some  also  in  stomach,  larynx,  trachea,  and 
bronchi.  Some  marks  of  injuiy  on  face  and  other  parts  of  body.  In- 
ternal signs  of  asphyxia.  Opinion  given,  that  the  case  was  homicide. 
The  defence  ofPered  was  that  the  man  had  fallen  into  the  grain. 

66.  Rauscher : FriedreicKs  Blat.,  1886,  xxxvii.,2jp.  324-330. — ^Vo- 
man,  age  71,  suffocated  by  a  cloth  over  nose  and  mouth. 

See  Tidy,  "Med.  Jur.,"  Cases  1  to  11. 


DEATH  FEOM  SUBMERSION 


IN   ITS 


MEDICO-LEGAL  EELATIOE'S. 


BY 


lEVING  C.  ROSSE,  A.M.,  M.D.,  F.R.G.S.  (Eng.), 

Professor  of  Nervous  Diseases,  Georgetoivn  University;  Membre  du  Congres  Interna- 
tional d^ Anthropologie  Criminelle,  etc. 


DEATH  BY  SUBMEESIO]^  OE  DE0W:N'ING. 

GENERAL   CONSIDERATIONS. 

The  frequence  and  importance  of  drowning  having  arrested 
attention  from  the  days  of  Noah's  Ark  and  those  of  Hippo- 
crates down  to  the  present  time,  it  is  quite  possible  to  array  in 
chronological  order  the  fictitious,  transitory,  and  positive  periods 
that  mark  the  sequence  of  ideas  touching  the  subject. 

Mooted  questions  relative  to  drowning  have  been  debated 
since  the  fourteenth  century;  and  modern  statistics  show  the 
great  development  of  this  class  of  emergency,  than  which  none 
is  of  more  startling  character.  In  France  between  four  and  five 
thousand  cases  of  this  kind  of  accident  are  officially  recognized 
each  year,  which  is  about  one-third  of  all  the  accidental  deaths, 
and  the  number  appears  to  increase  yearly.  Nearly  the  same 
figures  apply  to  the  inland  waters  of  England  and  Wales,  not 
including  the  coast.  The  Board  of  Trade  Return  shows  that 
out  of  86,695  seamen  who  died  in  English  ships  abroad,  53,673 
were  drowned,  and  a  late  report  of  the  Fisherman's  Federa- 
tion places  the  number  drowned  in  the  inland  waters  and  upon 
the  immediate  coasts  of  the  United  Kingdom  and  its  adjacent 
islands  as  6,268  annually.  The  many  hundreds  drowned  in 
the  late  Victoria  disaster  and  in  the  great  storm  that  swept 
the  British  Isles  are  matters  of  current  knowledge.  In  our 
own  country  accounts  of  drowning  are  of  daily  occurrence,  and 
help  to  the  drowning  forms  the  greater  part  of  the  work  done 
by  that  noble  governmental  branch,  the  Life  Saving  Service. 
Not  only  does  the  sea  claim  its  numerous  victims,  but  the  great 
floods  and  cyclones  have  destroyed  thousands,  while  on  the 
lakes  and  rivers  drowning  accidents  are  lamentably  frequent. 
If  the  statistics  of  such  accidents  were  as  available  as  those  of 
the  late  war,  for  instance,  the  exhibit  would  doubtless  be  sur- 
prising. Where  the  aggregation  of  killed  in  action  is  shown 
to  be  67,058,  there  were  drowned  106  officers  and  4,838  men. 

795 


796  DEATH   FROM   SUBMERSION — ROSSE. 

The  small  regular  army  lost  5  officers  and  89  men  from  this 
cause ;  the  negro  troops,  6  officers  and  289  men ;  and  the  volun- 
teers furnished  a  large  contingent,  the  State  of  Ohio  alone  hav- 
ing lost  14  officers  and  770  men  from  drowning.* 

Aside  from  the  point  of  view  of  public  hygiene  and  that  of 
pathology,  further  evidence  is  not  wanting  to  show  the  medico- 
legal value  of  the  phenomena  of  drowning,  and  the  frequency 
and  importance  of  the  judicial  questions  that  may  arise  in  this 
class  of  accidents. 

DEFINITION   AND   PHENOMENA   OF   DROWNING. 

Late  studies  as  to  the  cause  and  mechanism  of  asphyxia  by 
submersion  or  drowning  warrant  our  speaking  of  submersion 
as  immersion  complete  enough  to  menace  or  to  extinguish  life. 

When  an  animated  body  or  a  part  only  of  the  body  is  im- 
mersed a  sufficient  time  in  water  or  any  liquid  mediuin  what- 
ever in  such  a  way  as  to  exclude  fresh  air  from  the  respiratory 
orifices,  suffocation  follows,  and  death  by  submersion  or  drown- 
ing takes  place. 

The  phenomena  occurring  in  such  instances  are  mostly  those 
common  to  imperfect  aeration  or  non-aeration  of  the  blood,  and 
for  this  reason  the  majority  of  medical  writers  describe  asphj^xia 
or  apnoea,  that  is,  death  beginning  at  the  lungs,  as  the  deter- 
mining cause  of  death  by  drowning.  It  must  not  be  thought 
that  asphyxia  is  always  the  mode  of  death  in  those  submerged, 
although  it  is  commonly  present  in  a  certain  number  of  cases. 
Other  causes  may  often  modify  the  circumstances  of  the  death 
or  directly  produce  it,  as  congestion  of  the  brain  and  syncope, 
or  the  cause  of  death  may  be  a  mixed  one.  Occasionally  one 
reads  accounts  of  persons  resuscitated  from  drowning  who,  on 
recovering  from  the  primar}^  effects  of  the  asphyxia,  die  sud- 
denly without  apparent  cause  after  a  lapse  of  a  few  minutes 
or  several  days.  Such  cases  are  explained  as  the  secondary  re- 
sults of  the  arrested  interstitial  nutrition  that  took  place  during 
the  period  while  breathing  was  temporarily  arrested.  Another 
secondary  cause  is  phj^sical  injury  to  the  lungs  from  water 
penetration,  which  may  result  in  a  fatal  pneumonia.     A  case 

'See  writer's  "Bathing  and  Boat-       Medical    Association,    April    19th, 
ing    Accidents,"    Jour.    American      1890. 


MODE   OF   DEATH   IN    DROWNING.  797 

related  in  England  last  summer  is  that  of  a  drowning  boy 
who,  on  being  resuscitated  after  submersion  in  contaminated 
water,  suddenly  died  of  cholera. 

MODE   OF   DEATH   IN   DROWNING. 

Since  various  lesions  may  be  found,  accordingly  as  the  death 
from  drowning  has  taken  place  from  one  or  more  of  the  fore- 
going modes,  it  is  necessary  to  have  a  clear  notion  of  asphyxia 
and  to  study  in  detail  the  mechanism  of  arrest  of  the  thoracic 
movements  and  of  the  hindrance  to  hgematosis. 

Broadly  speaking,  there  will  be  asphyxia  when  any  obstacle 
hinders  air  from  entering  the  pulmonary  vesicles,  or  when 
the  fluid  that  penetrates  them  is  of  any  other  nature  than  the 
medium  in  which  the  animal  is  destined  to  live.  Consequently 
the  name  asphyxia  is  applied  generically  to  all  accidental  con- 
ditions in  which  life  is  threatened  by  any  intervention  whatever 
of  the  respiration.  (See  Mechanical  Suffocation,  Vol.  I., 
p.  705  et  seq.,  and  Asphyxiating  Gases,  Vol.  IV.) 

Submersion  in  any  liquid  medium  causes  asphyxia.  This 
condition  may  be  caused  on  being  surrounded  by  a  medium  de- 
void of  oxygen  and  improper  to  support  sufficient  hsematosis, 
as  hydrogen,  nitrogen,  and  the  protoxide  of  nitrogen,  gases  not 
toxic  properly  speaking,  but  considered  irrespirable.  Dimin- 
ished respiration  from  deficiency  of  ox3^gen  is  the  true  cause  of 
asphyxia.  No  animal  can  maintain  the  respiratory  process  in 
an  atmosphere  devoid  of  oxygen  or  in  one  that  does  not  con- 
tain at  least  ten  per  cent  of  this  gas,  and  such  quadrupeds  as 
whales,  hippopotami,  and  seals  or  the  pygopodous  birds  would 
drown  in  the  same  manner  as  a  dog  if  kept  submerged  long 
enough.  The  suppression  of  the  gaseous  exchange  by  submer- 
sion is  also  fatal  to  such  aquatic  insects  as  hydrophiles,  dy- 
tiscidse,  and  the  like,  which  drown  in  the  same  manner  as  the 
hymenoptera,  coleoptera,  diptera,  or  other  terrestrial  insects. 
Ants  drown  in  less  than  a  minute  when  the  body  is  wet,  and 
the  disappearance  of  apparent  vitality  is  accompanied  by  con- 
vulsive movements  indicating  functional  trouble  of  the  nervous 
apparatus.  Sir  John  Lubbock  found  that  after  eight  hours  of 
immersion  they  could  be  restored  to  life,  and  several  ants  after 
two  days  and  five  days  were  restored  to  momentary  life  wit'i 


798  DEATH   FROM   SUBMERSION — ROSSE. 

feeble  motions,  followed  by  death  in  two  hours.  Even  a  terres- 
trial plant  when  submerged  drowns  like  a  terrestrial  animal,  the 
mechanism  of  asphyxia  by  submersion  being  the  same  in  plants 
and  aerian  animals,  and  due  to  closure  of  the  principal  way  of 
gaseous  exchange. 

Notwithstanding  the  interruption  of  the  gaseous  exchange 
necessary  to  support  life,  there  is  long  persistence  of  vitality 
after  submersion  of  some  creatures  in  which  an  intra-molecular 
respiration  or  gaseous  dialysis  with  aerated  water  takes  place, 
as  in  ants  who  have  not  been  wetted  before  submersion. 

The  resistance  of  new-born  animals  to  this  mode  of  asphyx- 
iation is  especially  noted  in  the  greater  time  required  to  drown 
a  pup  than  an  adult  dog.  One  minute  and  a  half  usually  suf- 
fices to  drown  a  dog,  while  a  new-born  pup  often  requires  as 
much  as  fifty  minutes.  This  great  difference  is  owing  to 
the  less  active  change  of  tissue  and  the  smaller  consumption  of 
oxygen  in  the  young  animal.  The  more  active  the  vital  com- 
bustion and  the  greater  the  demand  upon  the  general  store  of 
oxygen  in  the  blood,  the  quicker  the  young  animal  perishes 
when  the  respiration  is  obstructed. 

It  is  observed  in  a  general  way  that  all  kinds  of  death 
caused  by  the  j^rivation  of  respirable  air  have  between  them- 
selves the  greatest  resemblance.  Whatever  be  the  obstacle  that 
intercepts  the  connection  of  the  lungs  with  the  atmosphere,  the 
apparent  differences  are  only  secondary  and  the  essential  symp- 
toms are  identical,  because  all  act  in  suppressing  the  functions 
of  the  blood  and  hsematosis.  In  fact,  the  phenomena  of  as- 
phyxia are  constant  and  related  to  disturbances  in  the  respira- 
tion, innervation,  and  circulation,  which  vary  according  as  the 
asphyxia  is  the  result  of  submersion  or  of  the  absence  of  oxygen 
in  the  surrounding  medium,  according  as  asphyxia  is  immediate 
or  slow.  The  fatal  result  of  asphyxia  is  owing  to  the  introduc- 
tory arrest  of  the  pulmonary  circulation,  the  capillaries  of  the 
lungs  being  incapable  of  conveying  venous  blood.  The  stagna- 
tion of  the  blood  in  the  lungs  is  followed  by  paresis  of  the  respi- 
ratory centre  and  stoppage  of  the  heart. 

STAGES  AND  SYMPTOMS   OF  DEATH  BY   DROWNING. 

The  authorities  are  that  an  individual  who  dies  asphyxiated 
by  submersion  passes  through  three  stages.     At  first  he  experi- 


STAGES   AND    SYMPTOMS   OF   DEATH   BY    DROWNING.        799 

ences  a  violent  shock,  followed  by  an  inspiration  of  surprise, 
which  results  from  the  contact  of  water  with  the  lungs  causing 
a  reflex  cough.  Then  for  some  seconds  there  is  a  voluntary 
suspension  of  respiration,  giving  rise  to  other  forcible  involun- 
tary expirations.  In  this  dyspnoeic  second  period  the  face  and 
brain  become  congested,  owing  to  slowing  of  the  encephalic 
circulation.  Loss  of  consciousness  soon  follows,  when  the 
drowning  person  enters  the  third  stage,  which  is  that  of 
asphyxia.  In  this  period  the  individual  gasps  deeply,  the 
pupils  are  dilated,  the  sphincters  paralj^zed,  and  the  limbs  are 
agitated  by  clonic  convulsions.  This  is  followed  by  complete 
insensibility  and  speedy  death. 

When  a  fatal  termination  in  drowning  results  from  that 
form  of  neuro-paralysis  known  as  syncope,  in  which  death 
begins  at  the  heart,  we  infer  from  experiments  that  the  sudden 
loss  of  consciousness  arises  from  the  violent  impressions  that 
the  sensitive  nerves  convey  to  the  bulb.  Such  a  result  is  more 
likely  to  occur  in  persons  with  weak  heart  and  languid  circu- 
lation, who  are  more  susceptible  to  fright  and  shock  or  to  the 
sudden  collapse  from  intense  cold.  It  is  also  shown  that  stam- 
merers, who  have  a  defective  innervation  of  the  phrenic  and  of 
the  pneumogastric,  succumb  more  rapidly  than  others. 

The  importance  of  sj^ncope  as  a  cause  of  death  in  drowning 
is  much  restricted  when  we  consider  the  fact  that  the  circula- 
tion is  the  last  of  the  functions  extinguished  in  an  animal  that 
for  purposes  of  experiment  has  been  subjected  to  submersion. 
This  has  been  shown  in  a  sensuous  way  by  experiment,  aided 
by  the  resources  of  the  graphic  method,  which  registers  the 
respiratory  modifications  as  shown  by  the  pneumograph  and 
also  the  condition  of  the  femoral  artery  in  connection  with  a 
kymographion.  The  heart  continues  to  beat  as  much  as  three 
minutes  after  the  animal  has  succumbed,  and  recent  autopsy 
gives  almost  constant  proof  of  asphyxia.  In  fact,  it  is  held 
that  syncope  takes  but  small  part  in  this  form  of  death,  the 
general  agreement  of  opinion  being  that  nothing  short  of  a  syn- 
cope that  would  be  fatal  either  in  or  out  of  the  liquid  medium 
can  account  for  the  entire  absence  of  some  of  the  signs  of  death 
from  asphyxia. 

Among  the  symptoms  often  present  in  drowning  persons, 
many  relate  to  nervous  phenomena  and  the  mental  state,  which 


800  DEATH   FROM   SUBMERSION — ROSSE. 

may  vary  with  individual  presence  of  mind  and  moral  force. 
Persons  who  have  escaped  this  kind  of  death  have  observed 
auditory  and  visual  hallucinations,  as  flashes  of  light,  the  ring- 
ing of  distant  bells,  and  the  like.  Just  before  the  outset  of  the 
asphyxiation  a  rather  curious  functioning  of  the  brain  known 
as  hypermnesia '  takes  place,  in  which  the  revivescence  of  ideas, 
of  objects,  or  of  facts  relates  to  anterior  impressions  long  past 
that  seem  to  have  been  forgotten.  According  to  the  narratives 
of  many  drowning  persons  who  have  escaped  the  last  conse- 
quences of  asphyxia,  this  condition  was  attended  by  general 
exaltation  of  the  memory  of  such  a  nature  that  their  whole  pre- 
vious conscious  existence  seemed,  in  an  incredibly  short  period 
and  with  great  clearness  and  precision,  to  pass  before  them  in 
panoramic  review.  In  Admiral  Beaufort's  letter  to  Dr.  Wol- 
laston,  the  memory  impressions  are  said  to  have  occurred  in 
retrograde  succession .  A  medical  man  resuscitated  from  drown- 
ing  reports  that  just  before  losing  consciousness  this  particular 
cerebral  activity,  in  his  case,  took  on  a  most  realizing  sense  of 
the  situation  and  of  the  consequences  to  his  family.  This 
cerebral  superexcitement  is  not,  however,  a  constant  thing,  nor 
do  all  subjects  experience  the  ineffable  agony  of  drowning. 
Persons  have  been  taken  from  the  water  apparently  dead  who, 
on  regaining  consciousness,  declared  that  they  experienced 
neither  oppression  nor  suffering  and  had  no  recollection  of  what 
had  passed.  A  very  intelligent  woman  of  my  acquaintance, 
having  such  an  experience  a  few  years  since  at  Newport,  quotes 
herself  as  and  really  believes  that  she  is  an  instance  of  a  person 
once  dead  and  afterward  restored  to  life. 

This  peculiar  vividness  of  mind  has  been  observed  in  other 
kinds  of  death  than  drowning,  notably  in  chronic  insanit}*. 
A  priest  with  extended  experience  at  the  Government  Hospital 
for  the  Insane  tells  me  that  he  has  often  noticed  the  vatwina- 
tio  morientinm  in  the  form  of  so-called  lucid  interval  of  the 
insane  when  called  on  to  administer  the  last  rites  of  the  Church. 
The  condition  is  explainable  from  the  stoppage  of  the  pulmonary 
artery  and  the  stimulus  caused  by  circulation  of  non-oxj^genated 
blood  in  the  brain. 

The  condition  known   as  asynesia,  or  amnesia,  sometimes 

^  See  writer's  article,  "Memory,  Diseases  of,"  in  " Reference  Handbook 
of  the  Medical  Sciences. " 


STAGES   AND    SYMPTOMS   OF   DEATH   BY   DROWNING.        801 

follows  the  return  to  consciousness  in  persons  asphyxiated  and 
apparently  dead  from  drowning.  Dr.  F.  A.  Burrell  reports  the 
case  of  a  boy  of  eighteen,  submerged  for  six  minutes  and  resus- 
citated after  four  and  three-quarter  hours,  in  whom  the  memory 
of  everything  that  had  occurred  from  half  an  hour  previous  to 
the  accident  up  to  return  of  consciousness  had  been  entirel}^ 
obliterated.  When  last  heard  from  the  lapse  of  memory  still 
remained.' 

The  statement  that  death  from  submersion  results  from  true 
asphyxia  or  from  asphj^xia  in  a  more  or  less  modified  form 
rests  on  the  authority  of  a  large  number  of  facts.  Indeed, 
recent  investigators  make  the  proportion  so  much  greater  than 
formerly  as  to  warrant  the  statement  that  asphyxia  is  the 
generic  cause  of  death  by  drowning.  Dr.  S.  Coull  Mackenzie  "^ 
reports  305  cases  of  drowning,  in  which  297,  or  93.37  per  cent, 
died  from  asphyxiation;  1,  or  .33  per  cent,  from  syncope;  1,  or 
.33  per  cent,  from  apoplex}'  and  asphyxia;  and  in  6,  or  1.9G  per 
cent,  the  mode  of  death  could  not  be  determined  because  of 
advanced  putrefaction. 

As  the  post-mortem  signs  of  drowning  are  known  to  vary 
according  to  a  number  of  circumstances,  it  is  difficult  to  deal 
with  the  subject  unless  certain  fundamental  points  be  kept  in 
mind.  These  relate  more  particularly  to  the  external  signs  and 
to  the  different  lesions  that  follow  the  mode  of  death,  although 
they  are  not  constant.  Surgeon-Major  E.  G.  Russell  ^  illustrates 
how  widely  the  post-mortem  appearances  may  vary  in  cases  of 
drowning,  even  when  the  outward  circumstances  of  the  period 
of  death  are  identical  and  the  bodies  have  been  subjected  to 
precisely  similar  conditions  as  regards  duration  of  immersion, 
subsequent  exposure  to  air,  and  times  of  necropsy.  He  relates 
that  five  persons  were  drowned  while  proceeding  to  a  ship  in 
the  Hooghley  River.  Three  died  the  same  death ;  and  at  the 
same  time  the  bodies  were  recovered  together  after  the  same 
period  of  immersion,  and  were  examined  together;  thus  from 
beginning  to  end  they  had  been  under  exactly  similar  conditions, 
yet  there  were  very  marked  differences  in  the  state  of  preserva- 
tion of  the  bodies  and  in  the  post-mortem  appearances.     After 

'  Medical  Record,  August  22d,  1891.  ^  Indian  Medical  Gazette,  Decem- 

- "  Medico-Legal     Experience     in      ber,  1888. 
Calcutta, "  Edinburgh,  1891. 
51 


802  DEATH   FROM   SUBMERSION — ROSSE. 

five  hours'  exposure  in  air  at  88°  F.,  one  body,  in  which  the 
tissues  were  extremely  fatty,  showed  beginning  decomposition; 
in  the  other  two  there  were  no  signs.  Decomposition  in  tho 
scalp,  face,  and  neck  indicative  of  drowning  had  begun  undc-r 
water,  although  in  ordinary  cases  it  first  invades  the  abdomen, 
genitals,  breasts,  etc.  Rigor  mortis  present  in  one  case  was 
absent  in  the  other.  The  penis  was  semi-erect  in  one  case, 
flaccid  in  the  other,  retracted  and  shrunken  in  the  third. 
Emission  of  semen  and  expulsion  of  faeces  were  also  noted. 
Tongue  not  swollen  or  protruded  in  any  case,  and  cutis  anserina 
absent  in  all  three,  which  may  have  been  owing  to  the  high 
temperature.  Water  was  inspired  into  the  lungs  in  two  cases. 
The  larynx,  trachea,  and  bronchi  had  regular  congestion  and 
scarlet  ecchymoses  in  one  case  characteristic  of  asphyxia,  and 
there  was  muddy  water  in  the  stomach. 

The  first  question  likely  to  arise  when  a  drowned  body  has 
been  found  is  the  one  of  identit}-.  All  the  circumstances  in 
which  the  body  was  observed  before  its  removal  to  the  place 
where  it  lies  for  examination  should  therefore  be  minutely 
detailed,  and  all  lethal  injuries  and  the  like  should  be  noted 
with  care,  since  the  smallest  accessories  often  lead  to  identifica- 
tion. The  locality  in  which  a  drowned  body  is  found  may  be 
a  fact  of  considerable  importance  that  may  help  to  complete  the 
chain  of  evidence  in  which  the  matter  of  crime  or  of  accident 
turns  upon  the  question  of  identity.  It  must  be  remembered 
that  bodies  often  drift  many  miles  away  from  the  spot  where 
the  drowning  occurred,  owing  to  tides  or  currents.  Such  a 
circumstance  I  noted  a  few  j^ears  ago  at  Brownsville,  Texas, 
where  it  was  a  common  sight  to  see  bloated  cadavers  going 
down  the  Rio  Grande.  Time  and  putrefactive  changes  are  also 
elements  that  enter  into  the  matter  of  recognizing  the  drowned 
cadaver.  To  resolve  this  question  with  desirable  precision,  tlie 
reader  is  referred  to  more  detailed  instruction  in  the  chapter 
on  Identity. 

TREATMENT   OF   THE  APPARENTLY  DROWNED. 

Help  to  the  drowned  does  not  properly  come  within  the 
province  of  judiciary  medicine,  being  rather  a  humane  question 
that  belongs  to  public  hygiene.  Systematic  writers,  however, 
treat  the  subject  at  considerable  length,  and  the  statistics  of 


TREATMENT   OF   THE   APPARENTLY    DROWNED.  803 

institutions  for  helping  tiie  drowned  give  such  marvellous  re- 
sults that  it  would  manifestly  not  be  out  of  place  to  cite  briefl}'" 
some  of  the  means  employed  for  restoring  life  to  persons  taken 
from  the  water  asphyxiated  and  apparently  dead. 

The  prime  object  in  resuscitating  the  drowned  is  the  intro- 
duction of  air  into  the  pulmonary  vesicles,  which  is  best  accom- 
plished by  artificial  respiration,  and  the  employment  of  such 
means  as  excite  the  nervous  system  with  a  view  to  reanimate 
sensibility  and  develop  the  reflex  movements  that  contribute  to 
the  re-establishment  of  the  respirator}'  function. 

The  exigencies  of  drowning  also  call  for  special  means  to 
restore  the  animal  heat  and  the  circulation,  as  well  as  the  pre- 
caution of  removing  mucus  and  fluids  from  the  obstructed  air- 
passages. 

As  the  knowledge  of  securing  patency  of  the  air-passages  by 
artificial  respiration  is  generally  diffused  among  medical  stu- 
dents and  is  taught  in  some  schools,  it  would  be  superfluous  to 
repeat  in  detail  the  procedures  of  Hall,  Sylvester,  and  others. 

Laborde's  method  of  resuscitating  those  apparently  dead 
has  lately  gained  some  notoriety.  It  consists  in  stimulating 
the  respirator}*  reflex  by  regular  rhythmical  traction  of  the 
tongue,  which  should  be  vigorously  pulled  forward  fifteen  or 
eighteen  times  a  minute,  to  correspond  in  frequency  to  the 
normal  respiration. 

Another  method,  alleged  to  have  marvellous  effects  over  the 
respiration,  is  that  of  anal  dilatation.  Its  advocates  claim  that 
irritation  of  the  anus  is  a  much  more  effective  measure  in  re- 
suscitating the  drowning  or  narcotized.' 

Respiration  may  be  further  promoted  by  alternate  dashes  of 
hot  and  cold  water  on  the  face  and  chest,  by  smelling-salts, 
tickling  the  throat  and  nares  with  a  feather,  and  by  electriza- 
tion of  the  diaphragm  and  inspiratory  muscles.  Protracted 
galvanism  may,  however,  prove  dangerous. 

When  signs  of  life  appear,  a  warm  tonic  stimulating  drink 
should  be  given.  A  hypodermic  injection  of  caffeine  is  also 
recommended. 

Whatever  means  are  employed  should  be  used  on  the  spot 
in  the  open  air  and  without  a  moment's  delay. 

Restorative  efforts  may  be  kept  up  for  two  or  three  hours, 
'  Jour,  of  Orificial  Surgery,  April  1st,  1893,  p.  709. 


804  DEATH   FROM   SUBMERSION — ROSSE. 

although  in  the  majority  of  cases  life  is  extinct  in  the  human 
subject  after  two  minutes'  submersion  or  even  less,  and  the 
chance  of  restoration  after  five  minutes'  complete  submersion  is 
doubtful.  To  be  sure,  trained  tank  performers  remain  under 
water  longer  than  two  minutes,  and  exceptional  instances  occur 
of  recovery  after  twenty  minutes'  submersion  in  individuals  in 
a  state  of  syncope  or  with  catalepsy. 

CADAVERIC   SIGNS  IN   CASES   OF  DROWNING. 

The  signs  alleged  to  be  common  to  death  by  drowning  and 
characteristic  of  it  are  difficult  to  deal  with,  for  the  reason  that 
there  are  no  sure  signs  of  drowning  and  the  lesions  furnished 
by  necropsy  are  of  feeble  importance.  There  is  consequently 
a  divergence  of  opinion  on  this  subject. 

External  Signs. 

Among  the  external  diagnostic  signs  consistent  with  the 
supposition  of  death  by  drowning,  the  presence  of  froth  at  the 
mouth  and  nostrils  is  of  first  importance.  Cadaveric  rigidity, 
pallor,  goose-skin,  rosy  or  violet  discolorations  on  various  parts 
of  the  body,  retraction  of  the  penis  and  scrotum,  fish-like  ex- 
pression of  the  eye,  peculiar  position  of  the  tongue,  maceration 
of  the  palmar  and  plantar  epidermis,  and  convulsive  contrac- 
tion of  the  limbs,  particularly  of  the  hands,  which  may  be 
clinched  after  the  manner  that  marks  death  by  asphyxia,  are 
all  signs  which  when  united  form  strong  presumption  in  favor 
of  submersion. 

These  typical  and  classic  signs  may,  however,  be  varied  by 
many  circumstances.  Hence  the  dissidence  of  authors.  Dr. 
F.  W.  Draper  states  that  after  inspecting  149  drowned  bodies, 
he  has  never  observed  that  important  sign  of  death,  the  pres- 
ence of  substances  grasped  in  the  hands.'  Sand  or  mud  in  the 
hollow  of  the  nails  and  excoriations  of  the  fingers  are  also 
regarded  as  probable,  not  certain,  signs,  since  each  of  these 
might  have  occurred  either  before  or  after  death.  The  peculiar 
clinched  condition  of  the  hand  is  not  pathognomonic,  though 
strongly  suggestive  of  drowning,  as  it  may  appear  in  asphyxi- 
ation from  other  causes.  I  have  lately  noticed  this  among  the 
'  Trans,  of  the  Massachusetts  Medico- Legal  Society,  vol.  i.,  No.  8,  1885. 


INTERNAL   LESIONS.  805 

external  appearances  of  the  bodies  taken  from  the  Pompeiian 
excavations.  Tlie  further  index  of  drowning  known  as  washer- 
woman's or  cholera  hand,  with  non-adherent  tendency  of  the 
epidermis,  is  an  effect  that  may  be  produced  upon  the  living 
after  a  prolonged  bath,  notably  in  the  aged  and  habitually  un- 
clean. Nor  is  the  position  of  the  tongue  a  special  and  distinc- 
tive characteristic  of  drowning.  Only  a  few  months  ago  I 
observed  its  presence  in  some  of  the  victims  of  mechanical  suf- 
focation in  the  Ford's  Theatre  disaster  in  Washington. 

The  shrunken  state  of  the  genital  organs  is  apparently  of 
little  i^ositive  value  as  a  thanatological  sign,  since  the  negative 
and  opposite  state  of  erection  has  been  often  observed,  and  Dr. 
Ogston  states  that  he  met  semi-erection  in  twenty-two  cases. 

The  value  of  "  goose-flesh"  as  a  link  in  the  chain  of  evidence 
is  also  weakened  when  we  consider  that  it  frequently  occurs 
after  other  violent  modes  of  death.  Anserine  skin  is  often  met 
with  during  life,  and  cases  of  drowning  are  recorded  where 
this  appearance  has  been  absent. 

The  aspect  of  the  face  and  the  general  position  of  a  drowned 
cadaver  may  likewise  var}"  according  to  the  mode  of  death. 
Immobility  of  the  body  in  the  attitude  of  agony,  the  horrible 
grimaces  of  asphyxia,  the  pale,  calm  features  of  syncope,  and 
putrefactive  changes  are  further  circumstances  of  medico-legal 
detail  that  may  complicate  the  problem  and  render  an  autopsy 
necessary  in  order  to  invalidate  or  confirm  the  uncertain  con- 
clusions furnished  by  the  external  signs. 

Internal  Lesions. 

Autopsies  on  the  drowned  are  remarkable  owing  to  their 
negative  signs.  But  as  an  extension  of  diagnostic  means,  the 
autopsy  ma}'  show  the  vertical  (though  not  invariable)  position 
of  the  epiglottis ;  the  presence  of  water  and  foreign  matter  in 
the  bronchi ;  swelling  and  emphysema  of  the  lungs ;  hydroemic 
engorgement  of  the  liver;  fulness  of  the  right  heart  and  empti- 
ness of  the  left;  fluidity  of  the  blood;  water  in  the  stomach  and 
middle  ear ;  and  a  characteristic  f rothj'^  mucus  or  lather  more 
or  less  bloody,  which  most  observers  and  writers  consider  the 
only  constant  post-mortem  appearance  of  drowning. 

Examination  of  the  respiratory  apparatus  is  of  extreme  im- 


806  DEATH   FROM    SUBMERSION — ROSSE. 

portance  in  a  question  of  this  kind,  for  it  is  contended  that  the 
presence  of  foreign  bodies  is  a  proof  of  submersion.' 

This  opinion  is  in  part  erroneous,  since  it  has  been  observed 
that  when  a  body  is  submerged  after  death  water  will  penetrate 
the  larynx,  trachea,  and  remote  bronchi,  as  well  as  the  stomach 
and  middle  ear.  Moreover,  Dr.  Ogston  states  that  in  48.7  per 
cent  of  cases  of  drowning  no  water  was  found  in  the  lungs. 

The  emphysematous  condition  of  the  lungs,  which  are  said 
to  force  their  way  out  of  the  chest  on  removing  the  sternum,  is 
difficult  to  distinguish  from  the  result  of  putrefaction.  Dr. 
Gilberti  shows  that  in  the  drowned  the  lungs  disintegrate  rap- 
idly, while  the  heart,  in  which  putrefaction  begins  chronolog- 
ically, is  relatively  in  a  good  state  of  preservation.'' 

Since  many  cases  have  been  observed  in  which  both  sides  of 
the  heart  may  be  partly  filled  or  both  be  empty  and  flaccid,  or 
the  left  side  distended  more  than  the  right,  we  are  obliged  to 
regard  the  exceptions  concerning  this  post-mortem  sign  of 
drowning  as  coextensive  with  the  rule. 

Excessive  fluidity  of  the  blood  depends  upon  the  rapidity 
with  which  the  drowning  took  place.  Slight  hydrsemia  occurs 
in  rapid  submersion,  but  when  the  drowning  has  taken  place 
slowly  a  large  amount  of  water  passes  into  the  blood.  In  cer- 
tain poisonings  by  opium  this  fluidity  also  exists;  but  it  is 
claimed  that  analysis  and  the  spectroscope  may  clear  up  the 
diagnosis. 

Hydrsemic  engorgement  of  the  liver  is  regarded  as  a  char- 
acteristic fact  by  Lacassagne,  who  claims  to  be  able  to  diag- 
nosticate drowning  from  a  single  examination  of  this  organ.' 

It  is  now  generally  admitted  that  the  presence  in  the  stom- 
ach of  a  certain  quantity  of  liquid  in  which  the  body  was  found 
immersed  may  be  considered  as  a  sign  almost  certain  of  as- 
phyxia by  submersion. 

Dr.  Fagerlund  concludes  from  his  experiments  that  liquids 
do  not  penetrate  after  death  either  the  stomach  or  anus  unless 
strong  pressure  be  made.  But  when  asphyxia  occurs  in  water 
the  liquid  is  found  in  the  stomach  and  the  intestines,  where  it 

'Lesser,  Dr.  Adolph  :  "Ueber  die  Annegamento  nel  Cadavere  in  Pu- 

wichtigsten     Sectionsbefunde     bei  trefazione, "  1889. 

dem  Tode  durch  Eitrinken  in  diinn-  ^Barlerin,    Paul,   le   Dr.:  "Etude 

fliissigen  Med ien,"  Berlin.  1884.  Medico-legale   sur  la  Submersion," 

■'Gilberti,  Dr.  A.  :  "ISegni  dell'  Tarare,  1891. 


ACCIDENTAL,  SUICIDAL,  OR   CRIMINAL.  807 

is  helped  on  by  peristaltic  movements.  The  pylorus  is  an  ob- 
stacle to  the  passage  of  this  water,  the  movement  of  which  is 
easier  when  the  stomach  is  emptj-  and  the  submersion  pro- 
longed.' 

The  quantity  and  quality  of  the  water  may  constitute  im- 
portant evidence;  but  to  be  of  full  value  the  water  or  other 
fluid  found  in  the  stomach  ought  to  be  the  same  as  that  in 
which  the  immersion  has  taken  place. 

The  liquid,  which  may  have  been  taken  just  before  drown- 
ing, should  not  be  noticed  unless  it  exceeds  half  a  pint ;  but  anj^- 
thing  peculiar  in  the  fluids,  either  of  the  lungs  or  stomach, 
should  be  subjected  to  microscopic  or  other  examination. 

Presence  of  water  in  the  middle  ear  is  regarded  as  a  thana- 
tological  sign  of  great  value.  Dr.  Bourgier  claims  as  the  result 
of  his  examination  that  23  cases  out  of  27  had  water  in  the 
middle  ear.  Several  German  observers  pretend  to  have  found 
amniotic  liquid  in  cases  of  foetal  asphyxia.  The  fluid  may  be 
aspired  b}'  a  small  pipette. 

Many  of  the  foregoing  signs  and  lesions  disappear  or  undergo 
variable  alterations  after  sojourn  in  water,  putrefaction,  etc. 
They  maj^  as  they  have  done  in  the  past,  give  rise  to  many 
controversies,  so  that  presumptions  only  can  be  established. 
Hence  the  necessity  for  careful  and  detailed  necropsy  in  such 
cases,  with  a  view  not  only  to  minimize  conjecture  and  uncer- 
taint}',  but  to  prevent  opposing  counsel  from  entering  the  plea 
of  negligence  and  incompleteness. 

WAS   THE    DROWNING    ACCIDENTAL,    SUICIDAL,    OR 
CRIMINAL? 

Assuming  the  probabilities  to  be  in  favor  of  death  by  sub- 
mersion, the  question  next  turns  upon  the  character  of  the 
event. 

In  the  absence  of  lesions  it  is  almost  impossible  to  say 
whether  the  individual  fell  in,  jumped  in,  or  was  pushed  in  the 
submerging  fluid.  The  person's  antecedents  should  be  inquired 
into — whether  subject  to  epilepsy,  vertigo,  intemperance,  or 
mental  aberration.     Alcoholism  is  an  important  factor  in  acci- 

'  Fagerlund,   L.   W.  :  "Ueber  das      jahrschrift  fiir  gerirhtl.  Med.  imd 
Eindringeu    von    Ertrankungsfliis-       off.  Sanitiitswesen,''  Berlin,  1890. 
sigkeit  in  die  Cedarnic,"   Viertel- 


808  DEATH   FROM    SUBMERSION— ROSSE. 

dental  drowning,  and  a  person  intoxicated  may  be  drowned  in 
very  shallow  water.  A  few  years  ago  a  young  man  over  six 
feet  tall,  while  bathing  in  a  tributary  of  the  Potomac  River, 
near  Washington,  was  drowned  in  only  three  feet  of  water. 
On  considering  all  these  circumstances,  it  may  not  be  possible, 
even  after  careful  inspection  of  the  body  and  minute  explora- 
tion of  all  the  organs,  to  declare  the  drowning  the  consequence 
of  an  accident.  The  existence  of  traces  of  violence  or  of  injury 
which  may  have  occasioned  death  or  disability,  of  such  a  nature 
as  to  render  the  person  unable  to  defend  himself,  would  seem 
to  merit  particular  attention.  But  their  presence  leads  to  fur- 
ther consideration — were  the  marks  of  injury  caused  by  the 
water  itself,  by  some  object  in  the  water,  or  were  they  self- 
inflicted?  Dislocations,  fractures,  and  other  injuries  have  been 
caused  by  jumping  or  falling  into  the  water  from  a  great 
height.  I  know  an  instance  of  a  professional  Vv'ho,  on  jumping 
from  a  height  of  ninety  feet,  split  his  upper  lip  on  striking  the 
water  with  his  mouth  open.  The  autopsy  in  the  case  of 
Odium,  the  Brooklyn  Bridge  jumper,  is  said  to  have  shown 
rupture  of  the  liver.  On  the  other  hand,  many  persons  jump 
from  great  heights  into  water  with  perfect  impunity.  For 
many  weeks  at  the  London  Aquarium  a  performer  has  nightl}' 
jumped  into  a  tank  from  an  elevation  of  137  feet,  and  several 
persons  have  successfully  jumped  from  bridges  much  higher. 

Objects  in  the  water  that  may  account  for  cadaveric  lesions 
are  numerous.  I  have  known  a  soldier,  a  good  swimmer,  to 
break  his  neck  on  diving  from  a  river  bank.'  Other  traumatic 
lesions  may  occur  in  a  rapid  current,  from  the  breaking  up  of 
ice,  from  the  screw  or  paddle-wheel  of  a  passing  steamer,  or 
from  aquatic  animals. 

A  matter  much  discussed  in  connection  with  this  subject — 
that  of  shark-bites — may  enter  into  the  question  of  survivorship 
where  it  is  alleged  that  several  persons  during  shipwreck  or 
other  disasters  at  sea  have  been  devoured  by  sharks.  Though 
an  occasional  accident,  such  bites  are  more  a  figment  of  the 
mind  than  a  reality,  as  the  concurrent  testimony  of  disinter- 
ested observers  will  show.  After  years  of  investigation  among 
nautical  people  and  much  experience  as  a  swimmer  in  widely 

'  Circular  No.  3,  War  Department,  Surgeon -General's  Office,  Washing- 
ton, 1871,  pp.  129-131. 


ACCIDENTAL,  SUICIDAL,  OR   CRIMINAL.  809 

different  parts  of  the  world,  I  have  no  personal  knowledge  of 
such  injuries,  and  have  met  hut  two  persons  that  had  any 
actual  personal  knowledge  of  shark-bites. 

Documentary  evidence  as  to  shark-bites  is  also  very  scanty. 
During  the  last  fifty  years  soldiers  by  the  tens  of  thousands 
have  swum  at  Fort  Monroe,  Virginia,  yet  there  is  no  record 
of  one  having  been  bitten  by  a  shark ;  nor  have  I  been  able  to 
ascertain  that  any  accident  of  the  kind  has  occurred  at  Malta 
or  at  Gibraltar.  There  does  not  appear  to  be  a  record  of  any 
■one  ever  having  been  bitten  off  the  British  Isles.  I  have  been 
unable  to  ascertain  that  a  single  bite  of  the  kind  is  reported 
among  the  medical  records  of  our  War  or  Navy  Department 
or  those  of  the  Marine  Hospital.  In  the  West  Indies  but  few 
facts  are  reported  indicating  danger  from  sharks,  and  these  are 
not  well  authenticated.  The  same  may  be  said  as  to  newspaper 
accounts,  which  deserve  about  as  much  credence  as  the  reports 
concerning  sea-serpents.  A  few  years  ago  a  public  journal 
gave  an  account  of  a  boy  who  was  bitten  while  swimming  near 
New  York  and  afterward  died  in  a  hospital. 

But  medical  literature  has  a  few  reports  of  shark-bites.  After 
ten  years'  diligent  search  I  have  found  seven  references, 
the  earliest  in  the  London  Medical  Gazette,  1823,  and  the 
latest  in  the  London  Lancet,  1886.  The  bites  occurred  in 
Australia,  South  Africa,  and  India.  The  Hooghley  and  Ganges 
Rivers  are  the  worst  place  in  the  world  for  sharks  and  alligators. 
A  particular  kind  of  shark,  the  Carcharras  Gangeticus,  which 
is  very  fierce  and  bold,  sometimes  dashes  among  the  crowds  at 
the  bathing  ghats,  and  has  been  known  to  bite  a  boy  in  two 
feet  of  water.  All  persons  bitten  at  these  places  generally  die 
from  the  bite,  for  the  reason  that  the  shark,  living  on  carrion, 
portions  of  which  stick  between  the  teeth,  carries  infection  to 
those  whom  it  may  afterward  bite.  The  former  habit  of 
throwing  the  dead  in  the  river  is  supposed  to  account  for  the 
boldness  of  these  particular  sharks  in  attacking  the  human 
species. 

Self-inflicted  wounds  rather  suggest  suicide,  as  numerous 
instances  attest,  where  one  or  two  kinds  of  death  were  intended 
to  make  assurance  doublj^  sure.  I  once  saw  an  Eskimo  stab 
himself  and  then  jump  overboard  from  a  ship  off  the  Siberian 
coast.     But  as  a  rule  suicidal  drowning  is  unaccompanied  by 


810  DEATH   FROM   SUBMERSION — ROSSE. 

traumatic  lesions,  unless  it  be  those  produced  by  falls.  Hence 
the  absence  of  lesions  leads  to  the  presumption  that  the  indi- 
vidual while  living  fell  into  the  water  or  other  fluid  accidentally 
or  voluntarily. 

Exception  may  be  made  in  the  case  of  infanticide  and 
homicidal  submersion  as  the  result  of  surprise,  where  a  person 
taken  unawares  is  suddenly  and  unexpectedly  pushed  or  thrown 
into  the  water.  A  case  in  point  is  that  of  a  man  suddenly 
robbed  and  seized  by  three  persons,  who  threw  him  into  the 
river.  Another  is  that  of  a  man  who,  wishing  to  get  rid  of  his 
wife,  gave  her  arsenic.  The  effects  of  the  poison  being  slow 
he  induced  her  to  take  a  walk  along  the  river,  and  when  her 
back  was  turned  he  pushed  her  rapidly  off  the  bank  into  the 
stream,  where  she  drowned.  Death  by  submersion  is  rarely  the 
result  of  murderous  intent,  and  in  the  case  of  adults  it  is  sud- 
denly resorted  to  in  order  to  paralyze  resistance  and  facilitate 
the  success  of  crime. 

Submersion  is  oftener  intended  to  hide  a  crime.  A  body 
may  be  taken  from  the  water  after  murder  or  rape.  Whether 
the  cadaver  is  recent  or  one  that  has  lain  in  the  water  a  long 
time,  the  expert  is  confronted  with  a  question  of  the  differences 
that  he  may  expect  to  find  in  a  body  drowned  and  one  thrown 
into  the  water  after  death.  This  difficulty  can  only  be  resolved 
by  considering  all  the  signs  and  lesions  furnished  by  the 
autopsy.  No  single  sign  or  post-mortem  appearance  is  charac- 
teristic of  drowning,  and  none  enables  us  surely  to  diagnosticate 
death  by  submersion  either  in  putrid  or  fresh  cadavers.  Nor 
do  we  have  any  significant  infallible  signs  that  may  serve  as  a 
parallel  between  the  immerged  post  mortem  and  the  submerged. 
The  exterior  signs  being  nearly  the  same  in  the  two,  the  diag- 
nosis must  necessarily  depend  upon  assembled  circumstances, 
and  these  are  liable  to  vary. 

CIRCUMSTANCES   THAT   MAY  AFFECT  THE   TIME   OF 
SUBMERSION. 

Putrid  decomposition  is  the  chief  obstacle  to  diagnosis  in  a 
body  that  has  been  drowned.  This  presents  great  differences. 
The  death  happening  in  winter  or  summer,  in  a  temperate  or 
intertropical  country,  and  sojourn  of  the  cadaver  in  salt  or  fresh 


CIRCUMSTANCES   AFFECTING   TIME   OF   SUBMERSION.        811 

water,  are  each  and  all  important  details  to  be  considered  in 
studying  the  submergence  of  a  bodj^.' 

It  is  only  by  studying  the  events  in  this  order,  along  with 
the  immediate  signs  of  death,  that  the  duration  of  the  sub- 
mergence may  be  conjectured.  With  anatomical  appearances 
as  the  only  guide  it  is  impossible  to  fix  the  time  of  immersion. 
Many  elements  combined  ma}^  affect  even  the  gaseous  putrefac- 
tion that  takes  place  in  submerged  bodies.  Summer  heat  and 
shallow  or  stagnant  water  hasten  the  development  of  putrid 
gas  and  subcutaneous  emphj^sema  which  bring  the  cadaver  to 
the  surface,  and  that,  too,  sometimes  in  spite  of  precautions 
taken  to  insure  the  submersion.  A  case  in  point  is  the  body 
of  the  Italian  admiral,  Caraccioli,  mentioned  in  Sou  they 's 
"Life  of  Nelson."  Bodies  weighted  with  lead  or  other  heavy 
substance  for  the  purpose  of  hiding  crime  have  also  been 
known  to  float  in  consequence  of  the  putrefactive  phenomena. 

At  Evansville,  Ind.,  unsuccessful  efforts  were  made  to  raise 
a  sunken  steamer  with  thirty  head  of  cattle  between  decks.  A 
few  days  after  the  attempt  was  abandoned  the  steamer  was 
suddenly  seen  to  float.  The  carcasses  of  the  putrefying  animals, 
swollen  by  gas,  had  sufiiced  to  bring  the  wreck  to  the  surface. 

A  great  development  of  gas  is  very  noticeable  in  what  is 
known  as  a  "  blasted"  whale,  the  stomach  of  which  assumes 
balloon-like  proportions.  A  few  summers  ago,  at  Province- 
town,  Mass.,  it  was  my  rare  fortune  to  be  within  a  few  feet  of 
an  enormously  distended  putrid  whale,  which  suddenly  ex- 
ploded. 

In  cold  countries  drowned  bodies  are  longer  in  coming  to  the 
surface.  In  Russia,  for  instance,  in  spring  after  the  rivers  and 
lakes  have  thawed,  the  bodies  of  numerous  victims  of  alcohol- 
ism and  accidental  drowning  of  the  previous  winter  are  taken 
from  the  water.  Last  summer,  at  Quebec,  I  was  present  when 
the  body  of  a  man  drowned  the  winter  before  came  to  the  sur- 
face of  the  St.  Lawrence  River.  On  a  visit  to  the  northern 
lakes  many  persons  connected  with  the  navigation  of  Lake 
Superior  told  me  that  bodies  drowned  in  its  waters  seldom  or 
never  came  to  the  surface. 

Specific  gravity  of  the  water  itself  may  be  an  additional 

'  The  subject  has  been  well  stud-       I'Anthropolosie  Criniinelle  et  des 
ied  by   Dr.    A.    Carre,    Archiv.   de      Sciences  Penales,  15Janv.,  1892. 


812  DEATH    FROM    SUBMERSION — ROSSE. 

cause  for  the  body  coming  to  the  surface.  Dr.  Tidy  says  that 
every  structure  of  the  human  body  floats  in  the  water  of  the 
Dead  Sea.  The  same  cannot  be  said  about  the  buoyancy  of  the 
water  of  Great  Salt  Lake,  the  accounts  of  which  have  been 
greatly  exaggerated.  It  does  not  "  support  a  bather  as  if  he 
were  sitting  in  an  arm-chair  and  float  him  like  a  fresh  egg." 
Experience  shows  that  there  is  no  difficulty  either  in  swimming 
or  in  sinking  in  its  waters,  the  solid  constituents  of  which  are 
estimated  to  be  about  six  and  a  half  times  more  than  that  of 
sea-water.  Analysis  of  Dead  Sea  water  places  the  solid  con- 
stituents at  24.580,  while  that  of  Salt  Lake  is  22.282.  An- 
ottier  strong  natural  brine  in  the  United  States  is  said  to  be 
that  of  Syracuse  Saline,  New  York,  which  contains  1?.35  per 
cent  of  sodium  chloride. 

It  is  evident  from  what  has  been  stated  that  no  positive 
assertion  can  be  made  as  to  how  soon  a  drowned  body  will  rise 
to  the  surface,  and  at  best  any  conclusion  as  to  the  date  of 
submersion  is  so  unsatisfactory  that  it  ma}^  be  said  to  be  an 
unscrupulous  use  of  guessing  privileges.  Errors  in  legal  med- 
icine are  sadder  in  their  consequences  than  those  of  medical 
diagnosis.  The  medical  legist  would  therefore  do  well  to  pre- 
serve the  frame  of  mind  that  often  doubts  and  rarely  affirms, 
and  he  should  be  circumspect  enough  to  avoid  dogmatic  asser- 
tions about  matters  of  uncertainty. 


DEATH   FROM  STARVATION. 

IN  ITS  MEDICO-LEGAL  ASPECT. 


BY 

ENOCH  V.  STODDARD,  A.M.,  M.D., 

Emeritus  Professor  of  Materia  Medica  and  Hygiene  in  the  University  of  Buffalo; 

Member  of  the  Medical  Society  of  the  State  of  New  York  and  of  the  Central 

New  York  Medical  Association;   Fellow  of  the  New  York  Academy 

of  Medicine  and  of  the  American  Academy  of  Medicine; 

Late  Surgemi  65th  Regt.  N.    Y.    Vols. ;  Late 

Health  Commissioner,  Rochester, 

N.  Y. ;  etc. ,  etc. 


STARVATIOJN". 

GENERAL  CONSIDERATIONS. 

Physiology  teaches  that  Hfe  can  only  be  maintained  in 
the  living  organism  by  a  constant  equilibrium  between  its 
waste  and  repair.  Nutrition  is  a  term  by  which  we  describe 
this  double  movement  of  renewal  of  the  molecular  structure  of 
the  body,  and  in  this  general  sense  only,  that  nutrition  is  synony- 
mous with  the  maintenance  of  the  organism  in  a  stable  condi- 
tion, is  it  employed  here. 

This  condition  of  equilibrium  is  maintained  by  a  regular 
and  constant  supply  of  food. 

A  food  may  be  defined  to  be  a  substance  which,  after  intro- 
duction into  the  bod}-,  supplies  material  for  the  renewal  of  its 
tissues  or  sustains  some  of  its  vital  processes.  Foods  vary 
greatly  in  their  properties  as  restorative  or  constructive  agen- 
cies, some  containing  but  few  essential  properties,  while  others 
combine  almost  all  of  the  elements  required.  As  some  foods 
contribute  elements  for  tissue  restoration,  others  are  specially 
concerned  in  the  calorifacient  activities  of  the  organism,'  while 
others  are  marked  in  their  tendency  to  take  part,  almost  exclu- 
sively, in  special  chemical  processes.'' 

The  various  articles  used  as  foods  contain  nutritive  ele- 
ments combined  with  innutritions  substances.  They  have  been 
variously  classified,  but  are  conveniently  divided  into 

I    Orrranir  foods   ■^"-   ^^*^"Senous(C.H.O.N.).      (  oieaLnnous 
L  Oigamcfood.,  ^,,    Non-nitrogenous  (C.H.O.),  ]  g^^^^^^^^^^^^^^^ 


TT    T  •      ^      1      i  «•  Water,  HoO. 

IL  Inorganic   foods,  ]  ,,    Saline  substances. 


Nitrogen  enters  largety  into  the  composition  of  the  body,  and 
hence  must  be  abundantly  supplied  and  in  combination. 

'Flint's  "Text-Book  of  Phvsiol-  -Foster,    "Handbook    of    Pliysi- 

ogy,"  Ed.  1877,  p.  517;    I.  Forster,  ology,"   Ed.    1880,   p.  457;    Kirkc's 

"Zeitschrift    fiir    Biologie, "    tome  "Handbook    of    Physiology,'-    11th 

ix.,  1872.  Ed.,  vol.  i.,  p.  311.  ' 


81G  STARVATION — STODDARD. 

Of  the  non-nitrogenous  elements  the  most  important  are  faty 
sugar,  and  starch. 

The  inorganic  principles  are  essential  to  the  process  of  nu- 
trition. Water,  constituting  87  per  cent  of  the  bulk  of  the 
body,  is  demanded  in  constant  supply;  while  the  saline  sub- 
stances are  necessary  for  the  perfect  performance  of  many  of 
its  chemical  processes. 

It  is  apparent  that  no  single  element  can  alone  carry  on 
the  nutrition  of  the  body,  and  hence  variety  in  the  supply  of 
food,  as  well  as  sufficiency  in  its  quantity,  is  essential  to  nor- 
mal nutrition.  Nor  are  these  the  only  factors  in  this  complex 
problem.  Proper  preparation  of  food,  its  supply  at  necessary 
temperatures,'  and  other  requirements  enter  into  the  question 
of  normal  or  sufficient  alimentation.^ 

Alimentation  is  sufficient  when  it  is  so  regulated  that  all 
the  functions  of  the  body  are  performed  in  a  complete  and  reg- 
ular manner.  Insufficient  alimentation  induces  a  series  of  phe- 
nomena and  a  result  which  have  been  designated  "  inanition, ^^ 
or  "starvation." 

The  exact  amount  of  aliment  required  by  each  individual 
can  only  be  stated  in  a  general  way.  In  the  circumstances  in 
which  he  is  placed,  the  supply  must  be  of  such  character  and 
quantity  as  shall  be  proportionate  to  the  constructive  and  repa- 
rative needs  of  his  body.*  It  is  possible,  however,  to  state  a 
mean  for  the  various  ages  and  occupations  of  life. 

Phj^siologists  generally  agree  that  in  ordinary  conditions 
of  exercise  the  following  represents  the  amounts  of  the  several 
food  elements  necessary  for  the  adult  individual  daily : 

Albuminous  substances 130  gms.  =  4  oz. 

Fatty  substances 60     "     =  2  " 

Carbohydrates 360     "     =12  " 

Taking  the  fatty  matters  as  the  unit,  the  daily  allowance 
would  bear  the  following  proportions : 

Fats,  1;  albuminoids,  3;  carbohydrates,  6. 

These  quantities  and  especially  the  fats  and  carbohydrates, 
in  conditions  of  hard  muscular  labor,  must  be  increased ;  and 
the  proportion  would  then  stand : 

'  F.    Spaeth,     "Archiv     fiir    Hy-  -Rochard,    "Encyclopaed.    d'Hy- 

giene,"  1886,  pp.. 68-81.  giene,"  vol.  ii.,  p.  796. 


ACUTE     STARVATION.  817 

Fats,  1;  albuminoids,  1.7;  carbohj^drates,  7, 

The  division  of  this  amount  of  food  elements  into  proper 
portions  during  twenty-four  hours  is  important.  This  must 
be  regulated  b}^  the  habits  and  other  circumstances  of  the  indi- 
vidual. ' 

The  occurrence  of  death  solely  from  privation  of  food  is 
comparatively  rare ;  yet  it  is  suflBciently  frequent  to  be  consid- 
ered as  one  of  the  causes  of  violent  death  and  to  demand  inves- 
tigation, since  circumstances  may  be  such  as  to  constitute  a 
homicide  from  criminal  neglect  or  a  suicide  from  intentional 
abstinence  from  food. 

"Starvation,"  or  "inanition,"  may  be  considered  as 
being  acute  or  chronic  according  as  the  requisite  food  has 
been  suddenly  and  completely  or  gradually  withheld. 


ACUTE   STARVATION. 

The  complete  deprivation  of  food  induces  a  series  of  modifi- 
cations of  the  functions  of  the  body,  differing  somewhat  from 
those  developed  by  a  partial  and  prolonged  deprivation.  The 
length  of  time  during  which  complete  absence  of  food  can  be 
endured  varies  with  circumstances.  In  absolute  stoppage  of 
the  food  supply  the  acute  sensatiori1K)f  hunger  pass  away  after 
the  first  one  or  two  days,  and  are  succeeded  by  profound  func- 
tional disturbances  with  weakness  and  depressing  sensations 
over  the  epigastric  region,  accompanied  by  distressing  thirst.^ 
The  mouth  is  dry  and  the  tongue  heavily  coated;  the  breath  is 
fetid;  the  skin  is  harsh,  dry,  and  exhales  a  disagreeable  odor; 
the  feces  become  more  and  more  scanty  until  the  latter  da3'S  of 
life,  when  diarrhoea  usually  supervenes ;  the  face  and  extremi- 
ties become  rapidly  emaciated ;  the  person  walks  with  a  weak 
and  tottering  gait ;  ^  the  urine  is  small  in  quantity  and  very 
acid ;  muscular  feebleness  gradually  reaches  complete  inability 
to  move ;  ringing  in  the  ears,  insomnia  and,  in  some  cases,  hal- 

'  For    elaborate    statements   con-  Ed.  1873,  p.  179;    Levy,  "Traite  de 

suit  Edward  Smith,  "Foods,"  Int.  Hygiene, "  vol.  i.,  p.  739. 

Sci.   Ser.,   N.  Y.  Ed.,  1878;    PavJ^  ^corrigan,      "On     Famine     and 

"On  Food,"  2d  Ed.,  1881,  N.  Y.,  p.  Fever."  etc.,  Dublin,  1849. 

467;    Buck,   "Hygiene,"  Ed.    1879,  sDonnivan,  "On  Famine,"  Dub- 

vol.  i.,  p.  190;  Parkes,  "Hygiene,"  lin  Med.  Press,  1848,  p.  67. 
.52 


818  STARVATION — STODDARD. 

lucinations '   with   delirium   and   convulsions   precede    death, 
though  these  latter  symptoms  are  not  uniformly  observed.^ 

"CHRONIC    STARVATION,"    "CHRONIC   INANITION." 

This  form  of  starvation,  met  with  most  extensively  during 
the  prevalence  of  famine,  also  occurs  in  conditions  demanding 
legal  investigation. 

The  symptoms  are  suflBciently  constant  and  characteristic. 
Emaciation  becomes  extreme,  the  skin  dry  and  rough,  exhaling 
a  disagreeable  odor  and  often  covered  with  a  coating  not  en- 
tirely attributable  to  filth;  the  breath  is  fetid  and  offensive. 
With  some  exceptions,  the  victim  retains  his  consciousness  and 
ability  to  move  about,  muscular  efforts  becoming  more  and 
more  feeble;  the  voice  becomes  faint;  the  evacuations  infre- 
quent, dry  and  dark ;  the  urine  scanty  and  high-colored,  death 
occurring  suddenh'  at  the  end,  with  delirium  in  some  cases. 

The  length  of  time  during  which  these  sj^mptoms  are  de- 
veloped and  their  intensity  depend  mainly  upon  the  amount 
and  character  of  the  aliment  actually  supplied  during  the  period 
before  death. 

Upon  the  pulse  and  circulation  the  effects  of  starvation 
are  manifest  in  increased  g:equency  and  feebleness  of  the  car- 
diac contractions  and  lesi^ned  force  of  the  cardiac  impulse ;  this 
is  more  and  more  marked  as  the  anaemic  condition  becomes 
profound.  In  some  cases  the  pulse  is  greatly  reduced  in  fre- 
quency, as  well  as  in  force,  dropping  as  low  as  thirty-seven 
beats  in  the  minute,^  and  auscultation  reveals  the  existence  of 
cardiac  bruits. 

In  connection  with  enfeeblement  of  the  circulation,  a  ten- 
dency to  hemorrhagic  conditions  is  common,  with  purpuric  and 
petechial  eruptions  in  some  cases. 

Temperature. — A  subnormal  temperature  is  frequently 
noted  in  the  progress  of  chronic  wasting  disease.  In  inanition, 
which  in  some  respects  induces  a  similarly  profound  disturb- 
ance of  the  functions  of  nutrition,  an  analogous  lowering  of  the 

'  Folet,  Ann.  de  Hygiene  et  de  Times  and  Gazette,  1861,  vol.  i.,  p. 
Med.  Legal,  2d  ser. ,  vol,  xlviii.  344. 

'■*  Sloan,     London    Med.    Gazette,  '^  Chossat.     "  Recherches     experi- 

vol.  xvii.,    p.    265;    Martin,    Med.       mentales     sur    inanition,"     Paris, 

1843,  p.  45. 


CHRONIC    STARVATION — CHRONIC   INANITION.  819 

body  temperature  occurs.  Chossat  clearly  shows  in  his  ex- 
periments the  influence  of  starvation  in  depressing  the  body 
temperature.  This  abasement  of  temperature  does  not  remain 
constant,  but  daily  oscillations  appear,  differing  from  those 
occurring  in  conditions  of  normal  alimentation. 

While  the  normal  diurnal  variation  in  the  fully  nourished 
is  about  0.3°  to  1.0°  C.  (0.5°  to  1.7°  F.),  in  the  starving  this 
variation  reaches  3.28°  C.  (5.4°  F,).  This  rises  to  nearly  double 
this  amount  during  the  latter  days  of  life,  and  is  greatly  in- 
creased above  this  figure  during  the  day  preceding  death. 
The  temperature  at  the  close  falls  to  a  mean  of  24.9°  C.  (76° 
F.),  and  at  the  moment  of  death  has  been  noted  at  18.5°  C. 
(66°  F.). 

Emaciation. — Loss  of  w^eight  is  the  most  striking  and  con- 
stant symptom  of  starvation.  The  rapidity  of  its  production 
and  its  extent  are  modified  by  circumstances.  A  very  consid- 
erable loss  of  weight  can  be  sustained  by  the  ordinary  individ- 
ual without  a  fatal  result. 

Chossat '  fully  demonstrated  the  effects  of  inanition  upon 
the  various  functions  and  organs  of  the  body  in  animals,  and 
has  drawn  the  conclusion  that  a  loss  of  weight  exceeding  four- 
tenths  of  the  entire  weight  of  the jbody  is  productive  of  a  fatal 
result.  These  deductions  may  be  gf^opted  as  applicable  to  the 
human  species.  This  statement  must  be  accepted  as  a  inean, 
as  it  is  capable  of  variation  by  circumstances,  such  as  age, 
obesity,  etc. 

Death  may  occur  before  so  great  a  loss  has  been  reached  in 
some  cases,  and  in  the  obese  the  fat  may  disappear  entirely 
and  cause  a  loss  reaching  five  per  cent  of  the  entire  weight  of 
the  body,  in  a  very  fat  animal,  without  a  fatal  result. 

Bouchardat  ^  considers  that  the  important  question  is  the 
extent  to  which  the  blood  and  organs  of  the  bod}'  contribute  to 
this  loss  of  weight.  Impoverishment  of  the  blood  b}^  inanition, 
which  at  the  time  of  death  has  been  found  to  amount  to  six- 
tenths  of  its  solid  constituents,  is  one  of  the  most  vitallj"  serious 
elements  of  this  loss;  and  a  relative  increase  of  its  water}"  por- 
tion appears,  without  regard  to  the  employment  of  water  as  a 
beverage. 

'  "Rechei'ches  experiinentales  sur  ^Bouchardat,  "Del' Alimentation 

inanition,"  1845.  insutiissant, "  Paris,  1852,  p.  10. 


820  STARVATION — STODDARD. 

It  must  be  remembered  that  in  wasting  diseases  extreme 
emaciation  may  occur  under  a  liberal  diet,  and  may  continue 
for  a  considerable  time  before  death.' 

The  muscular  system  becomes  greatly  enfeebled,  atrophied, 
and  unable  to  perform  its  functions;  the  loss  sustained  by  the 
muscles  least  used  being  most  marked.  The  extent  of  muscular 
power  possible  in  starvation  varies  in  different  individuals  and 
in  various  circumstances. 

The  vigorous  and  healthy  adult,  as  a  rule,  retains  muscular 
power  to  a  greater  extent  and  for  a  longer  period  than  the  child 
or  aged  person,  under  similar  circumstances. 

Exposure  to  a  rigorous  climate,  prolonged  fatigue,  etc.,  rap- 
idly reduce  capacity  for  muscular  effort  in  conditions  of  inani- 
tion. 

The  Period  at  which  Death  Occurs. 

This  is  influenced  by  many  circumstances.  It  is  difficult  to 
fix  an  exact  period  for  the  duration  of  life  in  complete  depriva- 
tion of  food,  or  acute  starvation,  and  it  is  certainly  more  so 
in  chronic  inanition,  when  the  modifying  circumstances  are  in- 
creased in  number  and  con^lexity. 

A  large  number  of  cases  of  prolongation  of  life  during  a 
period  of  absolute  deprivation  of  food  which  has  been  stated 
to  extend  over  weeks  and  even  months,  cannot  be  accepted  as 
free  from  error,  and  hence  are  not  considered  here. 

A  sufficient  number,  accurately  observed  and  well  attested 
by  unimpeachable  authorities,  have  led  to  the  conclusion  that 
the  healthy  adult,  in  a  total  deprivation  of  food,  can  exist  for  a 
period  not  exceeding  ten  to  twelve  days.  On  one  of  the  Inman 
line  of  steamers,  a  young  man,  aged  twenty  years,  endured  ab- 
solute deprivation  of  all  food  and  water  during  eleven  days,  re- 
covery following.^ 

Sarah  Jacobs,  a  child  of  thirteen  years  ("the  Welsh  fast- 
ing girl"),  had  been  exhibited  by  her  parents  as  a  miraculous 
being  under  the  pretence  that  she  had  eaten  nothing  during  two 
yearns. 

The  child  being  placed  ^under  complete  surveillance  by  four 

'  Greenfield,  ^Brit.     Med.    Jour.,  '^Dr.  McLoughlin,    London  Lan- 

Oct.  20th,  1877.    ^  cet,  Nov.  2d,  1878. 


THE   PERIOD   AT   WHICH   DEATH   OCCURS.  821 

nurses  from  Gu3''s  Hospital  for  eight  da3's,  during  which  period 
no  food  was  taken,  died  on  the  ninth  day. 

The  post-mortem  examination  showed  all  organs  of  the  body 
to  be  in  a  healthy  condition.  The  stomach  was  empty,  with  the 
exception  of  three  teaspoonfuls  of  a  thin  acid  fluid.  The  intes- 
tines were  also  empty  and  their  walls  were  not  thinned.  A 
layer  of  fat,  half  an  inch  or  more  in  thickness,  was  found  under 
the  skin  of  the  chest  and  abdomen.  The  liver  was  in  a  healthy 
condition,  as  also  the  kidneys  and  spleen.  The  bladder  wai 
empty. 

The  parents  were  tried  on  a  charge  of  manslaughter  and 
were  convicted  of  causing  death  by  criminal  negligence. ' 

Caspar  gives  the  details  of  a  case  observed  b}'  him  of  a 
man  aged  thirty-six  years,  who  endured  total  abstinence  from 
all  food  for  eleven  days,  recovery  following." 

Cases  are  reported  of  miners  who  have  been  imprisoned  by 
accidents  in  mines  for  eight,  nine,  and  nine  and  one-half  days, 
with  recovery  following  rescue  at  the  end  of  this  time."* 

While  the  period  stated  may  serve  as  a  maximum  limit  to 
which  life  may  be  extended  in  acute  starvation,  there  are  cir- 
cumstances which  must  be  considered  as  modifying  this. 

Body  Condition. — It  need  hardly  be  stated  that  the  indi- 
vidual in  perfect  health  can  sustain  complete  inanition  longer 
than  the  enfeebled  or  diseased.  The  presence  or  absence  oi  fat 
modifies  considerably  the  power  of  endurance. 

Age. — Infants  bear  starvation  badly  and  succumb  more 
quickly  than  the  adult.  The  aged,  while  they  bear  a  moderate 
amount  of  food  better  than  the  young  adult,  do  not  endure  a 
complete  deprivation  for  so  long  a  time. 

Cold. — The  depressing  influence  of  cold  upon  the  vital  func- 
tions, especially  in  the  young  and  feeble,  renders  it  a  powerful 
factor  in  shortening  the  duration  of  life  in  starvation. 

The  Supply  ofWater. — When  all  food  is  withheld,  free 
use  of  water  as  a  drink  tends  to  increase  the  length  of  the  inter- 
val before  death.  In  several  cases  of  protracted  fasting,  the 
use  of  water  in  moderate  amount   has  been  resorted  to  with 

'Reg.    V.   Jacobs  and  wife,  Car-  Syd.    Soc.    Pub.,    vol.    ii.,    p.    29; 

marthen    Summer    Assizes,     1890 ;  Lcmdon    Lancet,    April   11th,  1877, 

also  London  Lancet,   1890,  vol.  ii.,  pp.  580-620. 

p.  132.  ■   -^Thornhill,    Med.   Gazette,    Nov. 


'^  Caspar,    "  Forensic     Medicine, "      28th,  1835,  p.  39Q, 


822  STARVATION— STODDARD. 

the  apparent  result  of  amelioration  of  some  of  the  distressing 
symptoms  and  lengthening  the  period  of  endurance. 

Dr.  Tanner,  a  physician,  attempted  in  July  and  August, 
1880,  at  New  York,  a  complete  fast  of  forty  days'  duration,  with 
the  exception  of  the  free  use  of  water.  In  this  case  absolute 
abstinence  from  all  nourishment  is  questioned,  as  no  strict 
medical  surveillance  was  maintained. 

The  Italian  Succi,  at  New  York,  in  1890,  undertook  a  vol- 
untary abstinence  from  food  for  forty  days,  under  surveillance, 
with  the  use  of  simple  liquids  and  of  some  narcotic  substance. 
He  completed  the  fast,  but  beyond  this  fact  the  case  is  with- 
out scientific  value. 

Catalepsy. — Certain  abnormal  conditions  of  the  nervous 
system  are  met  where  the  activity  of  the  vital  functions  is  very 
considerably  lowered  and  the  various  processes  of  the  economy 
are  in  a  condition  of  semi-suspension.  Cases  of  this  character 
have  been  observed  where  the  supply  of  food  has  been  almost 
entirely  suspended  for  a  period  of  several  days,  with  but  little 
emaciation  and  other  symptoms  characteristic  of  inanition. 

WAS  STARVATION   ACCOMPANIED   BY  OTHER  ILL 
TREATMENT  ? 

This  question  may  aris«  where  evidences  of  starvation  are 
apparent. 

Such  cases  are  met  among  young  children  neglected  or 
abused  by  parents  or  those  in  whose  care  they  may  have  been 
placed,  or  among  the  alienated  or  sick  in  the  care  of  cruel  or  un- 
sympathetic attendants. 

Infants  placed  with  "  wet-nurses  "  or  found  in  the  so-called 
"baby  farms"  also  furnish  cases  which  fall  under  this  head. 

A  careful  examination  into  the  collateral  circumstances  of 
the  case,  together  with  the  results  of  a  careful  post-mortem  ex- 
amination, usually  render  a  positive  answer  to  this  question 
possible. 

POST-MORTEM  EXAMINATION. 

The  dead  body  exhibits  appearances  quite  characteristic. 

Emaciation  is  very  marked  and  sometimes  reaches  an  ex- 
traordinary degree,  surpassing  that  of  prolonged  and  wasting 
diseases. 


POST-MORTEM   EXAMINATION.  823 

In  extreme  cases  the  fat  entirel}'  disappears  throughout  the 
body ;  the  omentum  and  mesenteiy  are  entirely  devoid  of  it,  as 
well  as  the  subcutaneous  and  intermuscular  cellular  tissue. 
The  muscles  are  atrophied  and  the  heart  is  sometimes  consid- 
erably reduced  in  size ;  the  liver  and  kidneys  in  some  cases  show 
great  reduction  of  volume.  The  spleen  also  is  small  and  often 
softened. 

The  stomach,  and  intestines  usually  display  an  extensive 
thinning  of  their  walls,  so  muali  so  that  their  contents  maj'  be 
distinguished  through  them;  their  calibre  also  is  frequently 
found  to  be  diminished,  though  occasionally  they  may  be  dis- 
teuded  with  gas.  Usually  they  are  empty,  or  contain  only  a 
small  quantity  of  bile  and  fecal  matter.  In  some  cases  various 
foreign  substances  which  have  been  swallowed  by  the  victims 
to  appease  hunger  have  been  found  in  them. 

The  thinning  of  the  walls,  so  constantly  noted,  has  been  con- 
sidered as  a  specially  characteristic  symptom  of  starvation.' 

The  congestion,  softening,  and  ulcerations  which  have  been 
observed  in  some  cases  cannot  be  considered  as  evidences  of 
starvation  or  as  its  results,  but  rather  as  being  due  to  an  enter- 
itis induced  by  the  ingestion  of  improper  substances. 

The  gall  bladder  is  usually  f«und  filled  with  dark  and 
inspissated  bile.  In  death  by  starvation  the  entire  organs  of 
the  body  exhibit  no  specific  form  of  disease.  Evidences  of  the 
existence  of  an  organic  affection  observed  in  the  post-mortem 
examination  at  once  raise  the  question : 

WAS  DEATH   CAUSED    BY  STARVATION  OR    DISEASE? 

Was  the  original  disease  aggravated  by  a  failure  to  supply 
the  patient  with  food,  or  are  the  lesions  observed  the  result 
of  starvation?  A  positive  conclusion  can  be  reached  in  such 
cases  by  carefully  considering  the  results  of  a  post-mortem  ex- 
amination together  with  other  facts  elicited  by  the  inquiry. 

Harriet  Staunton,"  a  5'oung  girl,  had  been  kept  in  close  con- 
finement by   four   interested   persons,  and   removed   in   great 

'Caspar,     "Forensic    Medicine,"  '^"The    Penge     Case;"     Reg.     v. 

Syd.    Soc.     Pub.,    vol.    ii.,    p.    3G ;  Staunton,     Central     Crim.    Court. 

Martin,    Med.   Times  and  Gazette,  1817. 
March  30th,  1861  (Case  132). 


824  STARVATION — STODDARD. 

haste,  when  in  a  condition  of  extreme  prostration,  to  Penge, 
where  she  died,  on  the  day  succeeding  her  removal,  in  a  state 
of  extreme  exhaustion  and  emaciation.  Fat  was  absent  from 
every  part  of  the  body ;  the  stomach  and  intestines  were  empty, 
contracted,  and  their  walls  were  greatly  thinned. 

A  small  deposit  of  tubercle  was  found  at  the  summit  of  the 
left  lung  and  a  recent  deposit  of  miliary  tubercle  beneath  the 
arachnoid,  upon  the  surface  of  one  of  the  cerebral  hemispheres. 
No  other  tuberculous  deposits  were  found.  The  opinion  given 
by  the  physicians  making  the  post-mortem  examination  was 
that  death  resulted  from  starvation.  This  opinion  was  shared 
by  Professor  Virchow,  of  Berlin,  who  stated  that  the  tubercu- 
lous deposits  found  could  not  explain  the  cause  of  death. 

In  this  case  the  extreme  emaciation,  entire  absence  of  fat, 
thinning  of  the  intestinal  walls,  etc,  were  the  determining  con- 
ditions. While  extreme  emaciation  alone  is  not  suflScient  to 
decide  the  case  to  be  one  of  starvation,  its  existence,  taken  in 
connection  with  some  of  the  conditions  found  constantly  in 
persons  known  to  have  died  of  starvation,  is  a  strongly  corrob- 
orative fact.  Nor  can  its  absence  be  taken  as  conclusive  evi- 
dence that  death  occurred  from  other  cause  than  starvation, 
since  in  some  cases  of  deaSli  from  inanition  emaciation  has  not 
been  extreme  and  in  a  few  cases  not  at  all  marked,'  Instances 
of  this  character  are  reported  by  Taylor  and  others, 

DISEASES   PRODUCED  BY  STARVATION. 

The  effect  of  insufficient  alimentation  in  the  production  of 
disease  has  long  been  recognized.  It  is  understood  that  this 
result  follows  the  deficiency  in  either  quality  or  quantity.  The 
so-called  "famine  fever,"  prevalent  in  times  of  dearth,  has 
afforded  extensive  opportunity  for  observation  of  the  effects  pro- 
duced. The  symptoms  developed  are  those  directly  referable  to 
impoverishment  of  the  blood.  Pallor,  emaciation,  nervous  de- 
pression, derangement  of  the  digestive  organs,  and  muscular 
enfeeblement  appear  in  every  case. 

The  development  of  strumous,  herpetic,  and  cutaneous  dis- 
eases generally  is  marked. 

Of  the  secondary  effects,  the  cachectic  condition  induced  ex- 
'  The  case  of  Reg.  v.  Jacobs  and  wife. 


DISEASES  PRODUCED   BY   STARVATION.  825 

presses  itself  in  pulmonary  phthisis  largely,  while  in  infants 
and  very  young  children  intestinal  disorders  are  specially  fre- 
quent. Organic  diseases  already  existing  are  seriously  aggra- 
vated; wounds  fail  to  heal,  become  ulcerative  and  sometimes 
gangrenous ;  while  all  degenerative  processes  are  rapidly  hast- 
ened to  a  fatal  issue.' 

'Holland,  "On  Morbid  Effects  of  Deficiency  of  Food,"  London,  1839. 


'^ 


INDEX. 


PAGE 

Abdomen,  contusions  of, 580 

post-mortem  examination  of, 370 

wounds  of, 580 

Abdominal  viscera,  rupture  of, 583 

wounds  of, 583 

Abscess  of  brain 563 

Actions  to  recover  for  services  (see  Privileged  Communica- 
tions,)          26 

amount  of  recovery  in, 45 

elements  to  be  proved  in, 47 

evidence  in, 23-48 

Actions  for  malpractice, 73-87 

Adipocerb, 451 

Age,  determination  of, 399 

Alcoholism, 564 

Anthropometry,     .        .        .        .        .      f 432 

APNtEA, .*'....   709,  796 

Arteries,  wounds  of, 578 

Asphyxia, 708 

by  submersion, 790,  797 

external  appearances  due  to, 715 

internal  appearances  due  to, 718 

Autopsies, 301,  349 

in  cases  of  poisoning, 356,  371 

late, 378 

of  fragments 380 

order  of, jf        .        .        .        .  356 

Bills  for  services,  effect  of, 43 

Bladder,  rupture  of. 585 

wounds  of, 585 

Blank  charges,  woui^ds  by, 617 

Blood,  coagulation  of, 488,  701 

condition  of,  after  burns, 653 

extravasation  of,  in  brain, 565 

on  weapons, 535 

stains, 350 


828  INDEX. 

PAGE 

Body  (see  Dead  Body),  examination  of, 537 

temperature  of, 629 

Bones,  identification  of  human, 390 

old  or  recent? 391 

Books,  medical,  when  and  where  used  in  court,  .  .  .  .64 
of  original  entry,  when  admissible  in  evidence,  .  .  .  .48 
of  physician,  see  Privileged  Communications 

Brain,  abscess  of, 563 

concussion  of, 561 

congestion  of,  in  drowning, 796 

extravasation  of  blood  in, 565 

post-mortem  examination  of, 362 

wounds  of, 569 

Bui/LETS, 595 

loss  of  weight  of, 601 

track  of, 595 

Burking, 775 

Burns, 360,  639 

by  acids,        .        .        . 641 

burning  oil, 640 

corrosives 641 

electrical  currents, 664,  676 

flame 640 

fused  metals, 640 

lightning, 694 

petroleum, 641 

cases  of, 657 

causes  of  death  by, 645 

classification  of, 642 

constitutional  efifects  of, 644 

local  effects  of 643 

period  of  death  from, 649 

post-mortem  appearances  of, 647 

whether  ante- or  post-mortem, 6^9 

Cadaveric  changes  (see  Post-mortem),     ......  441 

Cadaveric  saponification, 451 

Cases  of  burns, 657 

of  hanging, 760 

of  strangulation, 726 

of  suffocation, 787 

Catalepsy, 822 

Cause  of  death,  see  Coroners 

from  burns, 645 

severe  mechanical  injury, 499 

submersion, 797 

wounds, 496,  497 


INDEX.  829 

PAGE 

Cause  of  Death, 

hemorrhage  as, 497 

latent  disease  as, 503 

shock  as, 499 

was  it  natural? 503 

wounds  as  secondary, 509 

Clothing,  examination  of, 353,  537 

Cold,  effects  of  extreme, 630 

Combustion,  spontaneous, G47 

Communications,  privileged  (see  Privileged  Communications),      .     33 
Compensation,  see  Physician  and  Patient ;  Expert  Witness;  Coi*- 
oners  ;  Medical  Examiners 

Concussion, 472 

of  brain, 561 

spinal  cord, 573 

Congenital  peculiarities,  identity  from, 403 

Constitutionality  of  statutes  regulating  practice  of  medicine 

and  surgery, 7-11 

Contracts  between    physician  and    patient  (see  Physician  and 

Patient), 25 

contre-coup, 559,  611 

Contusions, 358,  467,  470,  523 

by  lightning, 695 

of  abdomen, 580 

of  head, 558 

of  neck, 570 

Coroner  (see  Post-mortem  Examinations), 331 

is  virtute  electionis  in  America, 332 

duties  of,  are  both  judicial  and  ministerial, 332 

judicial  authority  of,  relates  to  inquiries  into  cases  of  death,     .  332 

jurisdiction  of, 332 

kinds  of,  at  common  law, 331 

presumption  that  he  has  acted  in  good  faith,        ....  332 
pi'otected  under  same  principles  which  protect  judicial  officers,    333 

Effect  of  evidence  and  verdict, 343 

at  connuon  law  was  equivalent  to  indictment  by  grand  jury,    .  343 
not  so  now,  yet  inquisition  has  same  power  until  grand  jury 

passes  upon  the  case,       . 343 

Evidence  before,  when  admissible  upon  a  subsequent  trial,      .        .  344 
Inquest,  all  evidence  must  be  presented  to  jury,         ....  342 
coroner  cannot  hold  a  second  inquest  while  the  first  is  undis- 
charged  334 

«oroner  has  power  to  hold, 332,  334 

is  a  jvidicial  investigation, 333 

must  be  held  in  view  of  the  body 335 

separate  inquests  must  be  held  over  eacli  of  several  bodies,       .  333 
Jury  and  inquest,  coroner  may  compel  attendance  of  witnesses,     .  341 


i> 


830  INDEX. 

PAGE 

Coroner, 

Jury  and  inquest,  jurors  must  be  from  jurisdiction  wherein  coroner 

is  empowered  to  act, 341 

jurors  must  be  sworn  by  coroner, 341 

jurors  must  investigate  and  determine  the  facts,  .        .        .  341 

jurors  must  view  the  body, 341 

jurors  not  challengeable, 341 

witnesses  must  be  sworn  bj' the  coroner, 342 

Massachusetts,  see  Medical  Examiners 

office  abolished  by  statute  in, 338 

statutory  provisions  in, 338 

who  may  hold  an  inquest, 338 

New  York,  coroner  may  issue  warrant  of  arrest  of  person  charged 

with  the  death 341 

must,  after  examination  of  charges,  hold  defendant  to  answer 

or  discharge  him, 341 

must  px'oceed  to  examine  charges  against  accused  upon  his  ar- 
rest,     341 

inquisition  and  testimony  must  be  filed, 340 

jurors  must  inspect  the  body  and  hear  the  testimony,  .  .  340 
jury  must  render  verdict  and  certify  it  by  an  inquisition,    .         .  340 

six  or  more  jurors  must  be  sworn, 340 

statutory  i^rovisions, 339 

testimony  must  be  reduced  to  writing, 340 

when  inquest  may  be  held, 339 

Powers  of, 

cannot  delegate  authonty  or  appoint  deputy 333 

contract  will  bind  county  for  payment  of  reasonable  compensa- 
tion,  .............  336 

may  employ  professional  skill  to  aid  him 335 

may  have  body  disinterred, 335 

may  issue  process  of  apprehension, 343 

Return  of  inquisition, 342 

inquisition  should  be  signed  by  the  coroner  and  jury,  .  .  343 
should  certify  that  witnesses  before  the  coroner  were  sworn,  .  343 
verdict  of  the  jury  is  final,        . 342 

Rights  of  accused  party  before, 342 

has  not  the  right  to  be  represented  by  counsel  or  to  cross- 
examine  witnesses, 342 

is  not  permitted  to  produce  witnesses  to  show  himself  innocent,  342 

privilege  of  prisoner  upon  arrest 344 

testimony  may  be  taken  by  the  coroner  in  his  absence,       .        .  342 
under  New  York  criminal    code  defendant   is   entitled  to  a 
hearing  before  a  magistrate, 344 

Craniometry, 394 

Cremation, 389 

Custom  of  phvsieians  to  serve  each  other  gratuitouslv,     .        .        .52 


INDEX. 


831 


301 


Dead  Body, 

autopsies, 

changes  in, 

chemical  examination  of, 

cooling  of, 

coroners'  duties  concerning  (see  Legal  Status  of,  Appendix), 
crimes  against  (see  Legal  Status  of,  Appendix),  . 

disposal  of. 

dissection,  when  permitted  (see  Legal  Status  of,  Appendix), 

district  attorney's  jjowers  concerning, 

duty  of  burial, 

examination  of  gunshot  wounds, 

exhumation  of, 

external  examination  of, 

flaccidity  of, 

internal  examination  of, 

legal  status  of, 

Appendix,  giving  statutes  concerning,  .... 
physical  examination  of  (see  Autopsies),  .... 
post-mortem  examination  of  (see  Autopsies  ;  Post-mortem  Ex 

aminers),    . 

putrefaction  of, 

right  of  burial  or  removal 

saponification  of, 

seizure  for  debt  forbidden, 

statutes  regulating  interment  or  exhumation,  etc.,  generally, 


Alabama,  .  .  309 
Arizona,  .  .  309 
Arkansas,  .  .  309 
California, .  .  310 
Colorado,  .  .  311 
Connecticut,  .  311 
Delaware,  .  .  312 
Florida,  .  .  .313 
Georgia,  .  .  313 
Idaho,  .  .  .313 
Illinois,  .  .  .  313 
Indiana,  .  .  313 
Iowa,  .  .  .314. 
Kansas,  .  .  .  314 
Kentucky,  .     .  314 

tempo  ratui-e  of,    . 
Death,  apparent, 

from  anaesthetics, 
burns,  causes  of,  . 
period  of. 
whether  accidental 


Louisiana,  .  . 

Maine,       .  .  . 

Maryland,  .  . 
Massachusetts, 

Michigan,  .  . 

Minnesota,  .  . 

Mississippi,  .  . 

Missouri,  .  .  . 

Montana,  .  . 

Nebraska,  .  . 

Nevada,    .  .  . 


B15 
315 
315 
316 
316 
317 
317 
318 
318 
318 
319 


New  Hampshire,  319 
New  Jersey,  .  330 
New  Mexico,  .  330 
New  York,     .     .  330 


North  Carolina, 
North  Dakota, 
Ohio,      .     .     . 
Oklahoma, 
Oregon,      .     . 
Pennsylvania, 
Rhode  Island, 
South  Carolina, 
Tennessee, 
Texas,    ,    .    . 
Vermont,  .     . 
Virginia,    .     . 
Washington, 
W(>st  Virginia. 
Wisconsin,     . 


suicidal,  or  homicidal? 


441, 


,  349 
441 
303 
441 
301 
299 
398 
303 
303 
298 
610 
300 
358 
443 
360 
397 
304 
303 

303 
445 
301 
451 
299 
304 
331 
331 
322 
323 
333 
323 
324 
324 
324 
325 
825 
335 
336 
336 
326 
453 
439 
516 
()45 
.549 
657 


o 


832  INDEX. 

PAGE 

Death,  from  cold, 633 

post-mortem  appearances  in, 034 

electrical  currents, 683 

hanging,  proof  of, 757 

latent  disease, 503 

natural  causes, 503 

slight  injuries, 507 

starvation, 813 

strangulation,  proof  of, 721 

submersion, 794,  798 

suffocation,  proof  of, 784 

surgical  operations, 515,  624 

wounds,  causes  of, 496,  497 

signs  of, 440 

time  of, 437 

Deformities,  identity  from, 403 

Delirium  tremens, 514,  624 

Diaphragm,  rupture  of, 57& 

wounds  of, 57^ 

Diploma  or  license,  how  proved  in  court, 20 

Dislocations, 476 

Drowning  (see  Submersion), 793 

Ecchymoses, 467 

ante-mortem, 444 

post-mortem, 443,  444,  485' 

Electric  cars,        . 668 

Electric  light,  effects  of,  on  eyes, 676 

Electrical  apparatus,  injuries  from, 664 

Electrical  currents,  burns  from, C64,  676 

direct  injuries  from, 671 

direct  symptoms  of  injury  from, 676 

fatal, ■     .        .682 

high  tension, 666 

indirect  injuries  from, 670 

injury  from, 664 

internal  symptoms  caused  by, 678 

mechanical  effects  of, 675 

mental  symptoms  from, 68^ 

muscular  contraction  from, 677 

Electrical  resistance, 673 

Electricity, 661 

medical, 664 

static,  . 673 

Electrocution, 683 

Erosion 471 

Erysipelas, 511 


INDEX.  833 

PAGE 

Examination  of  body, 537 

of  clothing, 537 

of  surroundings 541 

Excoriation, 471 

Experiments,  testing  powder-marks, 613 

with  cadavers, 607 

Expert  witness  (see  Privileged  Communications),  .        .        .       49-72 

compensation  of, 60 

competency  of, 61 

conduct  of,  in  court, 65 

definition  of, 53 

examination  of,  scope  of, 65,  68 

impeachment  of, 64 

in  civil  and  criminal  cases, 61 

medical  books,  how  may  be  used  in  examining,    .        .        .        .64 

practical  suggestions, 70 

summons  of  court  must  be  obeyed, 60 

system  in  Germany  and  France  compared  with  that  in  United 

States ' 54 

Exposure,  effects  of, 630 

Extremities,  wounds  of, 589 

Face,  wounds  of, 569 

Falls 549 

Faradism, 673 

Firearms,  evidence  from,       .        . 600 

examination  of, 612 

Flash,  identity  by, 619 

Footprints, 427 

Fractures, 359,  474,  491,  553 

by  gunshot  wounds, 610 

of  ribs, 574 

skull, 559 

spine, 571 

spontaneous,        .        .        .       ^. 474 

Gall-bladder,  wounds  and  rupture  of, 584 

Garrotting, 571,  707 

Genital  organs,  post-mortem  examination  of,        ...        .  376 

wounds  of, 588 

Gunshot  wounds,  see  Wounds,  Gunshot 

HiEMATOMATA, 468 

Hair,  identity  from, 406 

on  Aveapons, 535 

Handwriting, 434 

53 


834  INDEX. 

PAGE 

Hanging, 707,  735 

accidental,  cases  of, 774 

cases  of, 760 

homicidal, 759 

cases  of, 767 

judicial,  cases  of, 770 

post-mortem  appearances 746 

proof  of  death  by, 757 

suicidal, 758 

cases  of, 760 

symptoms  in, 740 

treatment  in, 744 

Health,  Boards  of,  see  Practice  of  Medicine  and  Surgery 

physicians  reporting  contagious  diseases  to,  not  liable  for  mis- 
taken reports, 23 

powers,  how  governed, 23,  24 

Head,  post-mortem  examination  of, 361 

wounds  of, 557 

Heart,  in  strangulation, 719 

post-mortem  examination  of, 366 

rupture  of, 578 

wounds  of, 575 

Heat,  effects  of  extreme, 635 

Hemorrhage, 483,  497,  716 

Hypostases, 443,  716 

internal, 444 

Identification, 383 

by  flash  of  gunpowder 619 

from  congenital  peculiarities, 403 

deformities 403,  430 

entire  skeleton, 392 

imprints .  427 

injuries, 403 

scars, 419 

stigmata, 426 

tattooings, 421 

teeth, 401 

in  death  from  submersion, 802 

of  burnt  remains, 389 

human  bones, 390 

mutilated  remains, 408 

recently  dead,  entire  cadaver, 415 

surface  signs  for,' 419 

Imprints, 427,  542 

Incised  wounds,  see  Wounds 

Infants,  liability  of,  for  medical  services, 37 


INDEX.  835 

PAGE 

Information,  duty  of  patient  as  to  (see  Physician  and  Patient),  .    33 

Injuries,  coag-ulation  of  blood  in, 488 

fatal,  actsperformed  after, 493 

identification  from, 403 

medical  inspection  of, 101 

of  abdominal  walls, oSO 

viscera, 580 

spinal  cord, 571 

spine, 571 

slight,  death  from 507 

whether  ante-  or  post-mortem, 482 

Inquest,  see  Coroners 

Insane  PERSONS,  liability  of,  for  medical  services,    .        .        .        .39 

Insolation, 636 

Insulation  of  electrical  conductors, 667 

Intestines,  post-mortem  examination  of, 371 

wounds  of, 586 

Kidneys,  post-mortem  examination  of, 370 

rupture  of, 584 

wounds  of, 584 

Larynx,  in  death  from  hanging, 754 

strangulation, 718 

post-mortem  examination  of, 369 

License  (see  Practice  of  Medicine  and  Surgery),        ....      7 

(or  diploma),  how  ])roved  in  court, 20 

licensed  physician  presumed  competent  as  an  expert  witness,  .     58 
licensed  practitioner,    pretending  to  be,  when  not  a   misde- 
meanor,       22 

statutes  requiring,  constitutional, 7 

suits  cannot  be  maintained  by  persons  without,  .        .        .        .18 
unlicensed  practitioner  not  presumed  competent  as  expert  wit- 
ness,    62 

when  may  be  compelled  by  courts, 14 

when  presumed, 19 

Lightning, 690 

burns  from, 694 

contusions  by, 695 

effects  on  internal  organs, 702 

loss  of  consciousness  from, 696 

memory  from, 696 

paralysis  from, 697 

pathology  of,  stroke  of, 700 

staining  of  skin  V)y, 69fi 

symptoms  produced  by, 693,  696 

wounds  by 695 


836  INDEX. 

PAGE 

Liver,  post-mortem  examination  of, 375 

rupture  of 582,  808 

wounds  of, 582 

Lungs,  in  death  from  strangulation, 719 

submersion, 805 

post-mortem  examination  of, 368 

wounds  of,    .        .        . 575 

Lymphorrhagia, 470 

Malpractice, 73-87 

abortion  is, .        .74 

civil  cases  concerning 80 

contributory  negligence  in, 87 

criminal  cases  concerning, 73 

damages  for, 83 

definition  of, 73 

degree  of  care  and  skill  in, 80 

evidence  in, 84 

inspection  before  trial  in,  . 85 

partners  liable  for, 84 

Maxxlicher  RiFiiE,  effects  of, 619 

Marks  of  powder, 608 

Married  women,  liability  of,  for  medical  services,  .        .        .        .37 
Master,  liability  of,  for  services  rendered  servant,    .        .        .        .39 

Massage,  not  practising  medicine  or  surgery, 28 

Medical  examiners,  see  #3roners 

contract  of  coroner  with,  binds  county  to  payment  of  reasona- 
ble compensation, 336 

coroners  may  employ, 335 

In  Massachusetts: 

cannot  hold  autopsy  unless  authorized,         .....  338 

cannot  hold  an  inquest, 338 

in  place  of  coroners, 338 

Medical  societies,  by-laws  of, 15 

fee  bill, 22 

Medicine  and  surgery,  see  Physician  and  Patient;  and  Practice 

of  Medicine  and  Surgery 
Muscular  contraction,  from  electrical  current,     .        .        .       .677 
Mutilated  remains,  identification  of, 408 

Nails,  identification  from, 406 

Neck,  contusions  of^ 570 

wounds  of, 569 

CEsoPHAGUS,  post-mortem  examination  of, 369 

Overlying, 774 


INDEX.  837 

PAGE 

Pancreas,  post-mortem  examination  of, 375 

Patient,  rights  of,  concerning  confidential  communications,  .    96 

Physician,  action  for  professional  services, 133 

his  books  containing  confidential  entries, 110 

his  rights  and  duties  concerning  confidential  communications,    132 
receiver  not  entitled  to  his  books  of  account,        .        .        .        .110 

what  is  a  professional  capacity? 133 

Physician  and  patient, 

contracts  between,  compensation  for  services 37 

conditional  and  unconditional, 34 

consulting  physicians, 44 

duties  of  patient, 29,  30 

physician, 28 

employment,  how  terminated, 26,  28,  30 

may  be  declined 24 

estates  of  deceased  persons,  when  liable  for,  .        .        ,        .43 

express  or  implied 26 

express, 27 

implied,  elements  of, 28 

infants,  liability  of, 43 

insane  persons,  when  liable, 45 

married  women,  generally  not  liable, 43 

masters,  liable  for  services  rendered  servants,        .        .        .45 

measure  of  recovery  for, 45 

patient  presumed  liable, 37 

person  calling  in  j^hysician  not  presumed  liable,  .  .  36,  41 
physicians  treating  each  other,  vmen  they  may  recover,  .  47 
railway  company,  when  liable  for,  in  case  of  accident,  .  42 
railway  physicians,  authority  of,      .        .        .        .        .        .42 

relation  of  physician  and  patient, 119 

compensation  for  services,  right  to  sue  for  in  United  States,       .     20 

how  lost, 19 

students'  services, 44 

skill  and  care  required  of  (see  Malpractice),  .  .  .28.  31,  32,  33 
schools  of  medicine  not  recognized  by  courts,  .  .  .15 
standard  of  school  professed  must  be  attained,  .  .  .31 
stranger  may  not  be  called  in  without  patient's  consent,     .    29 

Pithing, 572 

Poisoning, 597 

Position  of  victim, 541,  540 

Post-mortem  appearances,  in  death  from  burns,  .       .        .  047 

cold 034 

hanging 740 

starvation, 822 

strangulation, 713 

submersion, 801,  804 

sunstroke 638 


838 


INDEX. 


Post-mortem  changes, 

eechymoses, 

hypostasis, 

lividity, 

rigidity, 

Post-mortem  examinations  (see  Autopsies,  Coroners), 


PAGE 

.  441 

443,  485 
.  443 
.  443 

442,  453 
.  354 


when  and  how  made  by  coroner, 337 

Post-mortem  wounds, 355 

Powder-marks, 608,  612 

Practice  of  medicine  and  surgery  (see  Physician  and  Patient),  7-25 
acquirement  of  right,  regulated  by  statutes,         ....       7 

constitutionaUty  of,  statutes  regulating, 8 

criminal  cases,  jjroof  of 19,  22 

license  for,  may  be  compelled, 14 

how  proved, 20 

medical  societies  and  by-laws  of, 14 

15 

22 

14 


fee  bills, 

massage  not,  ..... 
patent  medicines,  .... 
statutory  regulations  concerning,  in: 


Alabama,     . 

.  137 

Arizona,  .     . 

,  139 

Arkansas,    . 

.  140 

California,   . 

.  141 

Colorado,     . 

.  144 

Connecticut, 

.  145 

Delaware,    . 

.  148 

Dist.  of  Columbia,  149 

Florida,  .     .     . 

.  150 

Georgia,  .     . 

.  151 

Idaho,     .     . 

.  152 

Illinois,    .     . 

.  153 

Indiana,  .     . 

.  155 

Iowa,  .     .     . 

.  157 

Kansas,    .     . 

.  160 

Kentucky,  . 

.  160 

Lij^Hsiana,  . 

.  162 

Msune,     .     . 

.  164 

Maryland,    . 

.  165 

Massachusetts 

.  167 

Michigan,     . 

.  167 

Minnesota,  .  .168 
Mississippi,  .  .  169 
Missouri,  .  .  .  171 
Montana,  .  .  .173 
Nebraska,  .  .175 
Nevada,  .  .  .177 
New  Jersey,  .  .  178 
New  Hampshire,  181 
New  Mexico,  .  181 
New  York,  .  .  183 
North  Carolina,  189 
North  Dakota,  .  191 
Ohio,  ....  193 
Oklahoma,  .  .  193 
Oregon,  .  .  .  194 
Pennsylvania,  .  197 
Rhode  Island,  .  203 
South  Carolina,  203 
South  Dakota,  .  204 
Tennessee,  .  .  205 
.     .  207 


Utah 209 

Vermont,  .  .  211 
Virginia,  .  .  .  212 
Washington,  .  215 
West  Virginia,  219 
Wisconsin,  .  .  222 
Wj'oniing,  .  .  223 
Great  Britain,  .  224 
Scotland,  .  .  224 
England.  .  .  224 
Ireland,  .  .  .  224 
Brit.  Columbia,  238 
Manitoba,  .  .  242 
N.  Brunswick,  248 
Newfoundland,  255 


N.  W.  Terr.,  . 
Nova  Scotia,  . 
Ontario,  .  .  . 
Prince  Edw.  Is., 
Quebec,    .     .     . 


258 
262 

268 
278 
284 


Texas,  .    . 

Privileged  communications, 91 

cause  of  death, Ill 

communications  to  physician  not  privileged  at  common  law,    .     91 

"confidential  communications," 115,118 

between  physician  and  patient,  when  privileged,         .        •     94 
dependent  upon  professional  capacity, 98 


INDEX.  839 

PAGE 

Privileged  communications, 

effect  of  excluding  privileged  evidence, 130 

evidence  admitted  not  to  be  commented  on.  ....  Ill 

in  criminal  actions 101 

in  lunacy  proceedings, 103 

of  abortion, 102 

of  adultery, 102 

of  crime  in  civil  actions, 101 

of  criminal  intimacy, 102 

of  habitual  drunkenness, 103 

of  value  of  physician's  services, 133 

to  establish  privilege, lOG 

function  of  the  court, 128 

ground  of  privilege, 91 

harmless  admission  no  ground  for  exception Ill 

how  evidence  of  physician  taken  in  New  York,    .        .        .        .97 

how  privilege  established, 131 

in  actions  for  divorce,        .         .        .        .    • 102 

in  criminal  actions, 101 

"information," !»7.   115 

"matters  confided," 99 

"matter  committed," 97,  118 

"matter  necessary  to  enable  a  physician  to  prescribe  or  a  sur- 
geon to  act," 124 

mental  condition  of  patient, 103 

necessity, 98 

objections  to  evidence, 109 

when  made, 110 

objection  once  made  need  not  be  repeated, Ill 

partner  of  physician,  as  privileged  witness, 122 

patient's  ignorance  immaterial, 110 

rights  concerning  confidential  communications,  .        .        .        .96 

physician  defined, 105 

"  duly  authorized," 105 

as  witness  to  establish  privilege,  .•        .        .131 

physician's  advice,      .        .        . 98 

books, 1^     .  110 

cannot  refuse  to  disclose  when  patient  waives  privileg*^      .     99 

knowledge, 98 

presumption  from  failure  to  give  privileged  evidence.  .  130 

privilege  is  patient's,  not  physician's 107 

"professional  capacity," 123 

purpose  of  statutes  prohibiting  disclosures 9G 

relation  of  physician  and  patient, 119,  122 

result  of  legislation, 134 

rights  and  duties  of  physician, 132 

statutory  privileges  concerning  confidential  communications,   .     93 


840  INDEX. 

PAGE 

Privileged  communications, 

statutory  privileges  for  waiver  of  privilege, 96 

surgeon  defined, 105 

testamentary  causes,  .    • 103 

waiver  after  death  of  patient,  in  New  York,  .        .        .        .98 

waiver  of  privilege  after  patient's  death, 108 

by  application  for  Insurance, Ill 

by  proof  of  death  to  insurance  company,        ....  Ill 

by  contract, 112 

by  Infant, .        .108 

by  patient's  attorney, 107 

by  representative  of  deceased  patient, 103 

by  requesting  physician  to  witness  will, 113 

certificate  of  death, .        .        .115 

effect  of 107,  110 

mfant's, 113 

taking  physician's  deposition, 112 

testimony  of  patient, Ill 

what  constitutes, Ill 

what  evidence  is  excluded, 97 

what  is  privileged, 115 

when  patient  may  be  contradicted%y  physician, .  .  112 

who  may  waive, 106 

whose  testimony  is  privileged, 105 

witness,  .        . .        .97 

Projectile,  course  of,    . 615 

evidence  from, 600 

Punctured  wounds,  see  Wounds 

Putrefaction, 445,  453 

circumstances  favoring, 447 

retarding, 448 

of  immersed  bodies, 450,  810 

PYiBMIA, 511 

Race,  determination  of,  from  hair, 393 

skeleton, 393 

Railwa^  companies,  when  liable  for  medical  services,    .        .        .41 
Railway  physicians,  authority  as  to  employing  nurses,        .        .    42 

Reports,  medico-legal, 381 

Resistance,  electrical, 673 

Respiration,  suspended, 439 

Ribs,  fracture  of,       .        .        .        .        . 574 

Rifle,  Mannllcher, 619 

Rigor  mortis, 442,  453,  701 

Rupture  of  abdominal  organs, .  582 

bladder, 585 

gall-bladder, 584 


INDEX.  841 

PAGE 

Rupture  of  heart, 578 

internal  organs, 553 

kidneys, 584 

liver, 582,  808 

spleen, 584 

stomach, 586 

Saponification, 451 

Scalds, 639 

Scars,  in  relation  to  identity, 419 

Schools  of  medicine  not  recognized  by  courts,       .       .       .       .15 

Septicemia, 510 

Sex,  determination  of, 400 

Sharks,  bites  of, 808 

Shock, 499 

Shot-guns,  wounds  by 607 

Signs  of  death, 440 

Skin,  marks  on, 419 

Skull,  fracture  of,    .       ^. 559 

measurements  of, 394 

Small  SHOT,  wounds  by, 617 

Smothering,     .       .        .  ? " 774 

Spinal  cord,  concussion  of, 573 

post-mortem  examination  of, 377 

wounds  of,   .        .        .        .        . 571 

Spine,  dislocation  of, 572 

fracture  of, 571 

wounds  of, 571 

Spleen,  post-mortem  examination  of, 371 

rupture  of, 584 

wounds  of, 584 

Spontaneous  combustion, 647 

Stabs, 463 

Stains,  could  assailant  have  escaped  without  ? 538 

Starvation,  acute,         . 817 

chronic, 818 

death  from, ^       .  813 

diseases  produced  by, *        .  834 

or  disease,  which  was  cause  of  death  ? 823 

period  of  death  from, 820 

post-mortem  appearances  in, 822 

whether  accompanied  by  other  ill-treatment 832 

Stature,  determination  of, 398 

Sternum,  fracture  of, 574 

Stigmata, 426 

Stomach,  post-mortem  examination  of, 373 

rupture  of, 586 


842  INDEX. 

PAGE 

Stomach,  wounds  of, 586 

Strangulation 707,  708 

accidental, 724 

cases  of, 734 

cases  of,         . 726 

external  appearances  due  to, 713 

homicidal, 725 

cases  of, 726 

internal  appearances  due  to, 727 

post-mortem  appearances, 713 

proof  of  death  by, 721 

simulated, 725 

stages  of, 710 

suicidal, 724 

cases  of, 732 

symptoms  of 708 

treatment  of, 712 

Struggle,  signs  of, 536 

Submersion, 793 

asphyxia  by, 796 

cadaveric  signs  in  death  by, 804 

circumstances  modifying  time  of, 810 

definition  of, 796 

mode  of  death  by, 797 

post-mortem  appearances, .        .  801 

stages  and  symptoms  of  death  by, 798 

•       treatment  of  apparently  drowned, 802 

whether  accidental,  suicidal,  or  homicidal,   .        .        .        .        .  807 

Suffocation, 707,  774 

accidental 785 

cases  of, 787 

by  submersion, 796 

cases  of, 787 

external  causes  of, 774 

Homicidal 785 

cases  of, 790 

internal  causes  of, 775 

mechanical, 705 

post-mortem  appearances, 781 

proof  of  death  by, 784 

suicidal, .        .        .  785 

cases  of, 790 

symptoms  of, 777 

treatment, 779 

Sunstroke 636 

Surgeon,  definition  of  term 56 

duties  of,  see  Physician  and  Patient 


INDEX.  843 

PARE 

Surgical  operations,  death  from, 515 

Survival, 556 

SyivX'OPE, 796,  799 

Tattooing, 42i 

Teeth,  determination  of  identity  from 401 

Temperature  of  body, 029 

of  dead  body, 441,  453 

Tetanus, 513 

Thorax,  post-mortem  examination  of, 365 

wounds  of,    . 573 

Time  op  death, 4:37 

how  determined, 452 

Veins,  air  in, .        .        .579 

wounds  of, 578 

Weapons, 853,  524 

evidence  from, GUO 

as  to  origin  of  wounds, 533,  549 

examination  of, ' 613 

presence  of  blood  and  hair  on, 535 

was  it  fired  from  a  distance  or  near  ? 612 

Witness,  see  Expert  Witness;  Privileged  Communications 

physician  as  expert  and  ordinary  -witness, 50 

when  must  testify  as, 60 

Wounds,     .        .       1 358, 457 

as  directly  cause  of  death, 497 

as  secondary  cause  of  death 509 

by  what  instrument  made? 517,  524 

cause  of  death  from, .    496,  497 

coagulation  of  blood  in, 488 

consequences  of  non-fatal, 556 

contused, 467,  470,  523 

death  from,  after  long  periods, f\.  508 

definitions  of, .        .         .  459 

description  of, 482* 

direction  of, 529 

eversion  of  lips  of, 489 

evidence  from  weapon, 533,  549,  600 

examination  of, 476 

from  crushing, 553 

falling 549 

lightning, 695 

gunshot, 593 

by  blank  charges, 617 

by  shot-guns 607 


844  INDEX. 

PAGE 

Wounds,  gunshot,  by  small  shot, 617 

complications  of, 624 

course  of  projectile, 615 

death  from  surgical  operations  in, 624 

description  of, 594 

dimensions  of  perforations, 609 

direction  of, 599 

examination  of, 594 

of  body  in, 610 

of  entrance,   ......' 614 

of  exit,    . 614 

situation  of, 598 

treatment  of, 620 

imputed, 544 

incised, 460,  517,  557 

diagnosis  of, ,        .        .        .  462 

kinds  of, 459 

lacerated, 471,  523 

mortal, 460 

nature  of, 548 

number  and  extent  of, 531 

of  abdominal  viscera, 580 

walls, 580 

arteries  and  veins, 578 

bladder, 585 

brain, 569 

^iaphragm, 579 

extremities, 589 

face, .        .569 

gall-bladder, 584 

genital  organs, 588 

head 557,  558 

heart, 575 

intestines, 586 

kidneys, 584 

liver, 582 

lungs, 575 

neck, 569 

spinal  cord, 571 

spine, 571 

spleen, 584 

stomach, 586 

thoracic  viscera, 573 

thorax, 573 

throat,  incised, 526 

origin  of,  evidence  from  weapons, 533,  549 

punctured, 463,  518,  557 


INDEX.  845 

PAGE 

Wounds,  regionally  considered, 557 

retraction  of  sides  of, 490 

severe, 400 

situation  and  position  of, 527,  548 

slight 400 

whether  accidental, 547 

ante-mortem  or  post-mortem, 482 

necessarily  the  cause  of  death, 500 

self-inflicted  or  by  another, 525.  544,  548 

which  of  several  was  first  inflicted? 554 

two  was  cause  of  death? 500 


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